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ANTHROPOMETRY 



AND 



Physical Examination. 



A BOOK 



FOR PRACTICAL USE IN CONNECTION WITH GYMNASTIC 
WORK AND PHYSICAL EDUCATION. 




BY 



JAY W. SEAVER, A.M., M.D., 

Medical Examiner and Lecturer on Personal Hygiene in Yale University. Lecturer 

on Anatomy, Physiology and Anthropometry in the Chautauqua School of 

Physical Education. Ex-President of the American Association 

for the Advancement of Physical Education. Member 

of the Connecticut State Medical Society, etc. 







(006 7 



tf-fi^ 



NEW HAVEN, CONN. 






Copyrighted 1896, by Jay W. Seaver. 



PRESS OF THE 0. A. DORMAN CO., 
NEW HAVEN, CONN. 



CONTENTS. 



CHAPTER I. 

HISTORY OF ANTHROPOMETRY. 

Its source in art. — Greek standards.— Roman and Egyptian 
canons.— German and modern art proportions. —Anthro- 
pological purpose— Its methods.— Pedagogical purpose. 7-16 

CHAPTER II. 

RECORDS AND INSTRUMENTS. 

Description of modern instruments.— The various books, cards, 
charts, etc., for general and private use.— What points 
should be noted. ..... • 17-34 

CHAPTER III. 

WHAT TO MEASURE AND HOW TO MEASURE. 

The technique of measurement.— The personal element.— 
The official list of items and rules of the American 
Assoc, for the Adv. of Physical Education.— Criticisms 
and suggestions. ...-•• 35~59 

CHAPTER IV. 

PERSONAL HISTORY AND EXAMINATION OF THE SPECIAL SENSES. 

The private record.— Family history.— Importance of the sense 

organs.— Directions for examining the eye, ear, etc. . 60-70 

CHAPTER V. 

TESTS OF STRENGTH. 

Importance for prescribing exercises.— The mercurial dyna- 
mometer.— Method of using.— Results obtained. .71-82 

CHAPTER VI. 

SPECIAL INSTRUMENTS. 

The pelvic obliquity and its measure.— Instruments.— The 

length of legs.— The deviations of the spine, etc. . 83-92 



4 Contents. 

CHAPTER VII. 

GRAPHIC ANTHROPOMETRY. 

The tabulation of data. — Averages, means, percentages, etc. 93-116 
CHAPTER VIII. 

THE LAW OF GROWTH. 

The increase in height and weight from birth to maturity, in 

males and females. .... 11 7-132 

CHAPTER IX. 

EXAMINATION BY INSPECTION. 

Training the eye. — What is to be seen from the various aspects. 

— Table. ...... 133-147 

CHAPTER X. 

EXAMINATION BY PALPATION. 

Methods and results. — Normal and abnormal conditions. — 

Tumors. ...... 148-153 

CHAPTER XI. 

EXAMINATION BY AUSCULTATION AND PERCUSSION. 

Methods. — Areas. — Normal sounds of lungs, heart, etc. — 

Abnormal sounds. ..... 154-167 

CHAPTER XII. 

THE SIGNIFICANCE OF CERTAIN PHYSICAL SIGNS. 

Discussion of heart sounds. — Sphygmograms. — Table of heart 

sounds. ...... 168-180 

CHAPTER XIII. 

PRESCRIPTION OF EXERCISE. 

The standard of physique. — Respiratory inefficiency. — Neuras- 
thenic cases. — Circulatory disturbances. — Prescription 
form. ....... 181-194 

CHAPTER XIV. 

THE EXAMINER HIMSELF. 

The need of physical training and the standard for the exam- 
iner. — Personal advice. . . . . 195-200 



PREFACE. 



The purpose of this book in its first edition was to 
place in the hands of directors of gymnasia, who were 
expected to examine people and prescribe exercise for 
them, a manual that should be a constant guide in secur- 
ing measurements and an efficient help in pointing out 
the vital matters that should be considered in making a 
physical diagnosis, or an estimate of the organic condi- 
tion of the various parts of the body and their habit of 
action. 

The purpose of the present book is the same as that of 
the former edition. The failures of the last have been 
partly eliminated and the methods of measuring more 
carefully discussed and illustrated, as well as the tabu- 
lation and comparison of material. 

The instruments for securing more exact data, espe- 
cially in new lines of research, have been given more 
attention, as it is believed that the most valuable anthrop- 
ometric work of the future will be done without attribut- 
ing so much value to space relation or size. The impor- 
tant question will be, What can the human machine do? 
and not, How large are its various parts? 

As an investigator in a new field of study who has 
already added much to our knowledge of the working 
power of the human body I mention Dr. J. H. Kellogg, 
to whom I am specially indebted for much new and valu- 
able material. I wish also to acknowledge the many 
courtesies that I have received from other authorities who 
have permitted the use of material for which credit is 
given in the text. 

Yale University, New Haven, Conn. 
June, 1896. 



I 



CHAPTER I. 



HISTORY OF ANTHROPOMETRY. 



There can be no study of more interest than that 
which pertains to human life and development. It is 
the center around which all thought and all energy crys- 
tallizes. Youthful ambition, parental solicitude and 
mature counsel all aim at the elevation of life to a higher 
standard and more complete form ; the child is to be 
better than the parent, the race is to evolve toward per- 
fection. 

The highest ideal of art has been to portray life in its 
most perfect form, whatever may have been the vehicle 
of the thought : stone, color, tone or word. The outward 
form and its action has also become the test of the inward 
man ; the thoughts, the impulses, the feelings, are recog- 
nized as having a physical basis that can be measured in 
some way and thus serve as a partial guide to the possi- 
bilities and probabilities of the future. Psychology 
looks for its material in the physical data that can be 
gathered, and no longer has its roots in speculation and 
personal opinion but in physiology. A determination of 
the law of physical growth for the human animal has done 
more to correct educational methods than any other in- 
fluence in pedagogy. Keen observation had made great 
teachers before but their method was never reduced to 
law. The nearest approach to this was the establish- 
ment of the Kindergarten by Froebel. But even here the 
establishment of the fact of a normal development of the 
control of fundamental muscles before the accessory has 
introduced vast improvement into the method. 

We must study then to "know ourselves" physically if 
we are to train ourselves into the highest type of mental 



8 History of Anthropometry. 

development as well as into the perfection of health and 
bodily vigor. In studying the law of organic growth it 
became necessary to record in definite terms the changes 
that characterized the various periods of life, and meas- 
urements of size and weight were made. Thus the 
knowledge of modern human proportions has been de- 
rived from the measurements of living persons of all 
ages and of both sexes. For this process Quetelet coined 
the apt word — Anthropometry. 

In considering the science of anthropometry it may be 
worth our while to glance somewhat briefly at its history. 
It is old as compared with other sciences, but it was 
developed primarily for purposes of art, rather than for 
those of physiology or anthropology ; and art, which is said 
to be "the daughter of the imagination, " did not con- 
sider originally the true proportions of the human body, 
but tried to represent an ideal that corresponded closely 
to the modern conventionalized forms, or so-called fash- 
ion. We see this in Egyptian art, where both hands 
were made right, and where a peculiar facial type is 
given which certainly did not represent the ordinary 
beautiful face of the race, but an idealized face. The 
development of art called for a closer adherence to the 
normal type of body, and probably the greatest incen- 
tive to imitate life came through the Greek admiration for 
the athlete, it being a law that the successful competitor 
at the Olympic games should have his statue carved in 
marble. The influence of this custom undoubtedly mod- 
ified Greek art favorably, and brought it to the highest 
standard that sculpture has ever attained. We knovv 
that certain artists, who were celebrated for the excel- 
lence of their work, left as their masterpieces statues that 
undoubtedly represent victors at these games. Polycleitos 
is said to have made five statues of victors at Olympia, 
and a head of Hera that was "like a verse from Homer." 



History of Anthropometry. 9 

The study of human proportions as related to art 
expression was carried to a high degree of perfection by 
Polycleitos, who, after mature study, sought to fashion a 
model that represented the ideal man. While this statue, 
called the Doryphoros or Spear Thrower, has been lost, 
undoubted copies of it in fair condition of preservation 
are extant.* 

The Doryphoros, "viriliter puer" was, in intent and by 
general consent, the representation of absolute perfection 
in human proportion. It; was the canon followed by suc- 
ceeding schools in portraying the highly developed fig- 
ures while the companion figure, the Diadoumenos, 
"molliter juvenis" constructed on the same proportions of 
length became the model of younger types. As a result 
of his minute study of human proportions this artist left 
a large number of statues, all of which are considered 
by art critics to be of a high standard of excellence. 

The Roman sculptors to a certain extent followed the 
Greek canons, and at the same time developed original 
lines of thought in connection with human proportions. 
We do not know, however, that they derived these ideals 
from many measurements of proportion, but have reason 
to believe that they were the result of the study of grace- 
ful forms and of ripened judgment in regard to physical 
beauty. The table of proportions given by Vitruvius does 
not give evidence of actual measurements taken and 
compiled but he probably drew on older canons — the 
Egyptian or the Greek. 

Among more modern artists the same effort to secure 
some law of proportion, that should apply to all artistic 
productions, has been made, and with comparatively little 
advance from ancient canons. The failure in these 

*See Reber's "History of Art," Waldstein's "Essays on the Art 
of Pheidias," Collignon's "Histoire de la Sculpture Grecque," and 
Sybel's "Weltgeschichte der Kunst." 



10 



History of Anthroponietry. 




Fig. i. 



methods has been from the attempt to find 
some one part of the body that should be 
a common measure of all the other parts ; 
as in the ancient Egyptian canon (Fig. i), 
where the length of the middle finger was 
considered a common measure of all the 
other proportions, five fingers being the 
height of the knee, ten fingers the height 
of the pubic arch, eight fingers the length 
of the arm to the tip of the fingers, three 
fingers being the length of the head and 
neck, and the total height being nineteen 
fingers. 

The physiologist Carus, of Dresden, 
conceived the vertebral column to be the 
unit of measure and this he divided into 
twenty-four parts, according to the num- 
ber of vertebrae, assigning to each the same value, as in 
embryonic life. 

The great German artist, Albert Diirer, of Nurem- 
berg, worked on a canon of proportion, considering the 
total height to be unity. The length of foot was one- 
sixth of this total, the head one-seventh, the hand one- 
tenth, etc. Diirer made the ratio of height between men 
and women as 17 to 18, while among English people the 
ratio is as 12 to 13. This showed his method to be that 
of the artist rather than of the anthropologist. The 
artist Schadow of Berlin, saw the failure of Diirer's 
canon and drew up tables of proportions derived by aver- 
aging the measures of various models, carrying the in- 
vestigation to the time of birth. 

Later artists have in general endeavored to follow the 
classic canons or to educe a new modulus after the 
Egyptian type and perhaps the most successful effort 
toward this end has been that of Story, whose method is 



History of Anthropometry. 1 1 

based on the mathematical relation of certain geometric 
figures. 

In the early half of the present century the strong 
trend of study toward the natural sciences led to the more 
thorough investigation of the natural history of mankind, 
and we find that more or less valuable treatises were 
published on anthropology. This gave a new impulse 
to the study of human proportions, for in studying differ- 
ent races of men it was found that they had marked 
peculiarities of physique, as well as marked mental 
peculiarities and customs. In 1870 Quetelet, who was at 
this time director of the Royal Observatory at Brussels, 
and a leading mathematician of his day, conceived the 
idea of assisting anthropology in its classification of 
human races by the determination of their physical pro- 
portions, believing that each race had such peculiarities 
as should constantly serve as a means of identification. 
He began this work with much zeal, and soon found that 
it had a much broader scope than he anticipated when he 
began his research. He writes in the first chapter of 
his book on anthropometry that he is appalled by the 
magnitude of the field of research into which he has 
entered. However, being accustomed to deal with num- 
bers, and having the enthusiasm of the true scientist, he 
proceeded in his work, and has given valuable material 
for all students of anthropology and anthropometry since 
his day. He was the first investigator to apply purely 
mathematical methods in determining the physical con- 
stants of the human body, and he demonstrated the "law 
of chance" as applied to human proportions. This so- 
called law of chance, or probability, has been found to be 
true in its general application. It has been made the 
basis of more recent investigations, and has been spe- 
cially applied in graphically representing the racial type ; 
as, for instance, in the representation of the difference 



12 History of Anthropometry. 

between tall and short races, as the Patagonian Indian 
and the Chinese. After establishing this law as applied 
to his own countrymen, he endeavored to determine the 
physical constants of other races, and perhaps the only 
criticism that can be made of his work is that he some- 
times drew conclusions from insufficient data. For in- 
stance, in determining the size of the American Indian, 
he concluded from the measurement of a few specimens 
that were on exhibition in Brussels that the Indian is of 
excessive height and size as compared with the ordinary 
European — which conclusion has been found by more 
recent investigators to be not in accordance with the 
facts. He did determine the fact that various races fol- 
low special laws in their growth and development, as do 
the various organs, and the discovery of this fact has led 
to important results, not only in anthropology but in 
physiology, as we find that those types having compara- 
tively long trunks and short limbs possess higher resist- 
ing power than the opposite types. We also find that the 
size of certain physical organs, like the chest, has a direct 
relation to the working power of the individual when 
considered as a machine. The relation of total size to 
the respiratory power is an important physiological fac- 
tor, as is also the relative length of different levers when 
the adaptability of the individual for special occupations 
is considered. It may be said that in more recent years 
the incentive to anthropometrical investigation has not 
lain in artistic or anthropological lines, but in pedagog- 
ical, psychological and hygienic. 

By far the greater part of anthropometrical work that 
has been done in the last twenty-five years has been done 
in connection with educational institutions and for edu- 
cational purposes, and it may be truly said to-day that 
the investigators who are most active are the ones con- 
nected with departments of psychological study. The 






History of Anthropometry. 13 

reason for this may be clearly seen in the fact that the 
racial type having been considered, the study of the in- 
dividual for the sake of bringing him up to a high degree 
of excellence becomes the next important duty of the 
educator. In this country especially it may be said that 
the work has tended in this particular line, while in Eng- 
land the research has been devoted to such departments 
as tend to the determination of general anthropological 
laws. In 1884 Francis Galton established in connection 
with the Health Exposition of London a bureau of 
anthropometry, for the purpose of gathering material 
that should determine the physical constants of English 
men and women, and serve as a check on work done be- 
fore on the Continent, and that might possibly lead to the 
discovery of new laws. A preparation for this work had 
been made by Charles Roberts of London when, in 1878, 
as secretary of the British Association for the Advance- 
ment of Science, he published the report of the Commit- 
tee on Anthropometry, and presented some interesting 
material gathered by himself. The material gathered 
by Mr. Galton was extensive and was studied by a new 
method, which has been quite generally adopted during 
the last fifteen years and which has a high utility in 
showing the distribution of proportions. His plan, in 
brief, was to group all the measurements of any particu- 
lar item, as height or weight, into percentile groups, or 
into such groups as could be represented by integral 
parts of one hundred. These measurements being 
grouped in this particular way made a determination of 
the mean easy {Vhomme moyen de Quetelef), and showed 
that the proportions, when so grouped, followed Quete- 
lef s binomial law of chance. This method enabled him 
to say of any given individual that he excelled a certain 
percentage of other persons, or that he was excelled by 
such a percentage of individuals in any item recorded. 



14 History of Anthropometry. 

This, therefore, became a valuable method of graphic- 
ally representing the size of any person, for, after having 
determined the distribution of the sizes of any particular 
item, the position of the individual in this distribution 
was easily determined. If, then, we group all the items 
of measurement of a similar class of persons, according 
to the percentile form, and have a table prepared that 
shows this distribution, we have an easy form of graphic 
representation. This method has been followed out most 
completely in this country as applied to the student 
classes of the community, no one as yet having under- 
taken the general measurements planned by Galton in 
England. The nearest approach to this English stand- 
ard for mature individuals is probably found in Gould's 
Sanitary Commission Memoirs, gathered from recruits 
who were examined during the Civil War. This memoir 
is a fairly comprehensive study of the actual and relative 
proportions of over a million men between the ages of 
sixteen and forty-five years. 

In our educational institutions we have largely followed 
the example set by Dr. Hitchcock of Amherst thirty-five 
years ago, in making a physical examination of the stu- 
dents who were admitted to the gymnasia connected with 
our colleges. In connection with this physical examina- 
tion a measurement of some of the more important items 
has been made. This method has resulted so satisfac- 
torily that it is now applied, not only to the students of 
the leading colleges and universities throughout the land, 
but in very many of the better class of secondary and 
private schools. This work has also been extended by 
the investigations of persons who have been interested in 
physiological or experimental psychology, and large 
numbers of school children of various ages have been 
measured and tested in order to determine, so far as 
possible, what relation might exist between physical con- 






History of Anthropometry. 15 

dition and intellectual activity. Tables representing 
these investigations will be found in another part of 
this volume. 

In this connection we must mention the very thorough 
study of the growth of American school children made 
by Dr. Bowditch in 1877. The result of his investiga- 
tions determined for the first time the law of growth for 
Anglo-Saxon children between the ages of five and six- 
teen years. This investigation had been preceded by a 
somewhat similar one, made by Dr. Fahrner of Zurich, 
Switzerland,* although his results never received the 
attention accorded to the work of Dr. Bowditch, because 
that of the latter was far superior in accuracy and extent. 
Dr. Geo. W. Peckham of Milwaukee, Wis., in 1880-83, 
made a study of the growth of school children, and a 
like investigation has been made in 1892-93, by Dr. W. 
T. Porter, upon children in the public schools of St. 
Louis, Mo., which confirmed the conclusions of Dr. 
Bowditch and established several new facts pertaining 
to the physical and mental growth of children. 

In 1893-4 Dr. E. M. Hartwell made a study of the 
relation of the nervous phenomenon of stuttering to 
growth and to the "specific intensity of life," among 
the school children of Boston. \ The term specific inten- 
sity of life is used to express the ratio between the num- 
ber of children living at any age and the number dying 
at that age. Incidentally he demonstrated the direct 
relation between the specific intensity of life and accel- 
eration of growth. 

The study of the nervous phenomena of school life and 
its relation to growth has been most thoroughly planned 
by President Hall of Clark University, and the results so 
far as published have given a basis for a critical discussion 

* Das Kind and der Schultisch. 

f School Document, No. 8, 1894, Boston. 



1 6 History of Anthropometry. 

of pedagogical systems that is already bearing fruit. In 
the same field of inquiry are found some papers by Dr. 
E. W. Scripture* of Yale, and Dr. J. Allen Gilbert. f 

Dr. G. W. Fitz of Harvard has also called attention to 
some of the nerve reactions that help to declare the 
condition of a person, J and has invented some instru- 
ments that record the time of reactions. In foreign 
countries the study of physical data obtained by an- 
thropometric tests has been carried to a high degree of 
perfection along physiological lines. Axel Key of 
Sweden has studied the relation of growth to tempera- 
ture and climate, as marked by the seasons of the year, 
and to the pubertal period. Bertillon and Demeny of 
France, Mosso and Livi of Italy, Schmidt and Voigt of 
Germany, and many others have made additions to our 
knowledge of the human body and its development. 
The problems of the future will lie in a determination of 
the influences affecting the neuro-muscular mechanism 
and its dominating center, the intellect ; the exact val- 
ues of heredity and nurture as the determining factors of 
a large part of life ; and the evolving of a pedagogical 
system that shall train the young to the highest possibil- 
ities of their faculties. 

* Ninth Annual Report Am. Assc. for Adv. of Phys. Education. 

f Studies from the Yale Psychological Laboratory, Vol. II. 

% Tenth Annual Report Am. Asso. for Adv. of Phys. Education. 



CHAPTER II. 

THE RECORDS TO BE KEPT AND THE INSTRUMENTS 
TO BE USED. 

For taking the measures of a person several instru- 
ments are needed; but the outfit may be very simple. 
For several reasons the record should be taken and kept 
in the metric system: ist. It is the scientific standard in 
use in all countries, and is in use in every other depart- 
ment of scientific investigation. 2d. It enables one to be 
~very accurate without trouble, as the unit is very nearly 
one twenty-fifth of an inch. 3d. There are no fractions 
to complicate compilation or computations, or records. 
4th. It helps to introduce an improved system of weights 
and measures into general use, and, as the ordinary per- 
son has no idea whether his record in English units is 
large or small, but only judges by comparison with the 
standard, he will get as good an idea by the metric sys- 
tem as by any other. 

The record book should be made of the best ledger 
paper and ruled transversely into spaces enough for all 
the items to be recorded. The perpendicular ruling can 
be made to divide the space into six columns, for the 
records when measurements are repeated. This will 
enable one to see at a glance what the change has been 
in any item, from time to time. If the space is econo- 
mized, there will be plenty of room on the two pages 
that face together to record the measures of three indi- 
viduals, six times each, and keep such items of history as 
should appear in such a book. The list of items recorded 
will be seen on page 95. 



1 8 Records and Instruments. 

It is advisable for each examiner to keep a private book 
for containing information of a purely personal nature, 
and for the guidance of the instructor in prescribing exer- 
cise. This private record will give him an amount of mate- 
rial for study and comparison in a few years. 

The books should be bound in volumes of about one 
hundred and fifty leaves, with heavy leather, as they are 
handled frequently. A second way of keeping the 
records, that has advantages in compiling the figures, or 
tabulating, has been devised by Dr. Swain. It consists 
of a card, with all the items, and room for two records of 
measurements. These cards are simply filed in alpha- 
betical order and kept for reference. In tabulating re- 
sults they are sorted over and placed in piles, according 
to any standard that may be taken, as height or weight, 
etc. It is not a desirable form for a permanent record 
but, as the personal property of the examiner, is prefer- 
able to a book. 

In the form of record book devised by Dr. Gulick for 
use in Y. M. C. A. work, the historical data are placed 
at the top third of the page, the remainder being divided 
into a column for prescription, and several narrow col- 
umns for measures. The number of items measured is 
smaller than the list prescribed by the American Associ- 
ation for the Advancement of Physical Education. 

It would seem that the card system of record could be 
used profitably in Y. M. C. A. work, as there is no spe- 
cial reason for permanently keeping the data except at 
some central bureau, where they can be tabulated for sci- 
entific purposes. In schools and colleges a permanent 
record is very important for history and comparison. 

A method of duplicating a record for the benefit of the 
person measured has been suggested by Dr. E. Hitch- 
cock, Jr., in connection with his graphic chart described 
later, and consists of a duplicate page to be inserted 



Records and Instruments. 



19 



under the record page with a sheet of carbon paper be- 
tween. By writing the record with a stiff pen the fig- 
ures are duplicated on the chart page. 

Another very satisfactory method of recording meas- 
ures is by the author's anthropometric table bound in 
book form, and the measures indicated on it by dots and 
lines ; or the actual record can be written at top or bot- 
tom and the graphic indications marked afterward. This 
gives a person looking over the record for special cases a 
comprehensive knowledge of the special form of the sub- 
ject at a glance, where the examination of a list of meas- 
ures even by an expert would be long and unsatisfactory. 
On the back is printed the following blank for historical 
data and a complete report on the physical conditions 
not capable of size relations. There is also abundant 
room for notes on the further development of the case, 
and the special exercises prescribed. 



Name, 

Birthplace, Date of birth, 

of Father, 

" " Mother, 

' • Paternal Grandfather, 

" " " Grandmother, , 

' ' Maternal Grandfather, 

" " " Grandmother, 

Occupation of Father, 

Father died of 

Mother " " 

Common diseases in family, 

Resembles in physical build, Father's Mother's family, 

Accidents and surgical operations, 

Diseases, 

Condition of eyes, Vision, J^| color-blind, 

" ears, hearing, nose, 

" " muscles, 

" " digestive organs, bowels, 

" kidneys, skin, 

" " lungs, 



Records and Instruments. 



Condition of heart, pulse, 

" " nervous system, sleeps, 

" " spine 

" " shoulders, legs, 

Previous work or exercise, 

health, 

Color of hair, 

" " eyes, 

Use of tobacco, 

Notes 



A card containing blanks to be filled with the historical 
matter by the person to be examined saves much time 
for the examiner and should always be used. The fol- 
lowing form is serviceable : 

Mr 

Your appointment for examination is 

at M. , at room Gymnasium. Please 

fill out this blank and bring with you at that time. 

The data here given will be considered strictly private, and will be 

retained by Dr 

Name in full 

Date of birth 18 

Birthplace of Self, Town State 

" Father, State 

" "Mother, " 

" Father's father, State 

4 * " Father's mother, *' 

'* " Mother's father, " 

" " Mother's mother, " ... 

Father's occupation 

Do you most resemble your father's or mother's family in physical 

build ? 

If either parent is dead, of what did father die ? 

Of what did mother die ? 

State any illness that has been common in the family, due to diseases, 
as follows : 

Heart Lungs 

Digestive organs Skin 

Kidneys Nervous system 

Scrofula Rheumatism 

Defective vision or physical peculiarity 






Records and Instruments. 



21 



Have you ever had any illness that confined you to the bed for two 
weeks, or more? , . . .What? 

Have you ever had trouble with the eyes ? or ears ? 

Can you breathe freely through each nostril ? 

Is your digestion good ? Are you ever troubled with 

bilious attacks ? or with constipation ? 

or chronic diarrhoea ? 

Is a cold more likely to locate in your nose, throat or lungs ? 

Do you suffer from nasal catarrh ? 

Do you faint easily ? 

Have you ever had palpitation of the heart ? 

Do you suffer from cold feet or hands ? 

Do you suffer from headaches ? 

Do you sleep well ? How many hours ? 

This private book should contain a careful record of 
personal peculiarities that may have a bearing on health 
and development. Any history of previous disease or 
accidental injury, even if recovery seems complete, 
should be recorded. Advice in regard to exercise and 
the results of the advice should be noted. This book 
should be a history of the person's 
physical welfare .during the past and 
while he is under observation, and 
thus correspond to a physician's case- 
book. The examiner will learn more 
from this record than from the book 
recording size and strength, when he 
studies the result of gymnastics. 

The following instruments are need- 
ed for measuring : 

i. A set of scales, with 
high bar for convenience 
in reading. These are 
made with metric gradua- 
tion (Fig 2). 

2. A graduated pole, 
with a slide moving at Fig. 2. 




22 



Records and Instruments. 



right angles on it for taking heights 

(Fig. 3). 

The arm of the slide should not 
be over 125 mm. long. The pole 
may have the metric system marked 
on one side, and the English on the 
other, like the one shown in the cut. 



n.l.l.l.l.l.l.l.l.i. U.l.l.J ftl.l.l.l.l.l. l.l.l, 



a 



1,1,1,1,1.1,1 



l.l.l.l.l.i.i.l.l.l. 



IT 



3£ 



1 Metre. 



Fig. 3. 

It is essentially two meter sticks, on one of which is fixed 
at the end an arm 125 mm. long, at right angles to it. A 
slide bearing a similar arm is made to run closely on the 
stick. The height is readily taken by holding the ends 
of the sticks together by the left hand while the right 
lowers the slide to the top of the head. Care must be 
taken to have the sticks perpendicular. The height 
sitting and the height of pubes and knee are taken with 
the one stick, which is much lighter and more readily 
handled than a long pole. The 
same stick, with slide, can then 
be used for taking the breadths. 

3. A pair of slide calipers (Fig. 
4), for taking breadths, will be 
needed if a pole is used for 



Fig. 4. 

heights different from the one described. This adds 
the expense as well as to the number of articles to 
handled. 







Records and Instruments. 



23 




4. A tape measure 
of steel (Fig. 5), or 
cotton (Fig. 6). The 
metal is uncomfort- 
able to the skin, but 
does not stretch and 
can be kept clean. A 
linen tape stretches on 

being moistened, and many subjects will sweat so freely 
as to wet a cloth tape. A painted tape is about as un- 
pleasant to the touch as one of steel. A tape must be 
renewed often and as the cotton tapes are inexpensive 
they are a very desirable form for general use. 



Fig. 5. 



SIM^MHD 


1 1 1 1 | 1 1 lj| 1 1 1 l| 1 1 Q| 1 1 1 1 1 1 1 ql 1 1 1 1 1 1 1 1 W 


f 


NARRM1MCTT WACHIBE CD 
PROVIDENCE. R.I. 


lll!|lllllll!|llllllll|llllllllllll llll|lllllll||llll |||l|!|ll |lll||||| INI Nil INI INK 



Fig. 6. 

A little instrument is made by the Narragansett 
Machine Co., at the suggestion of Dr. Gulick, for attach- 
ment to the end of a tape to indicate the proper tension, 
so that the pressure may be always alike (Fig. 7). It is 

a good device for the beginner, but useless after practice 

has given a habit in making the tension. 








TT 



_ 



Fig. 7. 

5. Calipers for taking depths (Fig. 8). These maybe 
of wood or metal and should have large extremities, so 
that a slight variation in pressure will not vary the rec- 
ord greatly by indenting the flesh. An index should be 



24 



Records and Instruments. 



on the instru- 
ment, for read- 
ing while in 
position and a 
spring should 
give a constant 
pressure while 
the instrument 
is being used. 

6. A capacity 
spirometer (Fig. 
9), for recording" 
the amount of 
air that can be 
inhaled and 
then exhaled, or 
the complemen- 
tal, tidal, and 
supplemental 
air of respiration. Hutchinson's wet spirometer is con- 
sidered the most reliable instrument of the kind (Fig. 
10). It is made in various forms and should record the 
capacity in liters. 

7. A stethometer or pressure spirometer is used by 
some persons, but is utterly worthless as far as informa- 
tion elicited by it is concerned. A person may blow by 
means of a rubber tube and suitable mouthpiece into an 
ordinary steam gauge that is made for recording low 
pressures, or an instrument devised by the author may 
be used. A piece of glass tubing of 5 mm. diameter is 
bent into the form of a right-angled triangle, having one 
angle of about 35 °. The side adjacent to this angle 
should be about 400 mm. long and should be horizontal 
when the triangle is fixed against a flat wall for support. 
A rubber tube with a glass mouthpiece is attached to> 




Records and I?istruments. 



25 



the short side, and mercury is drawn in to fill the hori- 
zontal part. Now, by blowing into the mouthpiece, the 
mercury is forced up the hypothenuse of the triangle. 
The graduation is easily made by measuring the per- 
pendicular line from the base to any point in the 
hypothenuse, and affixing a 
scale to the support back of 
the tube. The pressure will 
then be indicated in milli- 
meters of mercury column. 





Fig. 9. Fig. 10. 

8. A hand dynamometer (Fig. 11), for taking the 
strength of the flexor muscles of the forearm may be 
used where a universal mercurial dynamometer is not 
available. 



26 



Records and Instruments. 




COPYRIGHT IS «1 BY N. M. CO. 

Fig. ii. 



There are sev- 
eral forms of this 
instrument, the 
more common 
ones being the 
oval (Fig. 1 2), and 
the form with the 
two sides always 
parallel (Fig. 11), 
the resistance be- 
ing two spiral 
springs. This 
second form 
gives all the fin- 
gers an equal op- 
portunity to ex- 
ert their pres- 
sure. A ' ' push 
holder" (Fig. 1 3), 
and a "pull hol- 
der" (Fig. 14), are made to use with the oval instrument 
for enlarging its range of utility. 

9. A dynamometer for lifting with the back and legs, and 
taking the strength of the pectorals and retractor* of the 
shoulders is 
shown in 
Fig. 15. The 
instrument 
may be re- 
placed for 
the first t wo 
tests by a 
lifting ma- 
chine with 
spiral spring 
resistance, Fig. 13. 




Fig. 12. 




Records and Instruments. 



27 



and a graduated index applied from actual tests. The 
advantage of this latter form. is the quick adjustment to 
the height of the person. 







Fig. 14. 



10. 



Parallel bars for testing arm extensors in "Push 
up." A short pair of bars (Fig. 16), about 750 mm. long, 
attached to a frame with suitable braces, and made to 
move up and down against the wall, in being adjusted to 
any height desired, can be used for this test and also for 
the "Pull up, '' or test of flexors of the upper arm. Other- 
wise a horizontal bar, trapeze bar, or pair of swing rings 
must be used for this last test. This bar frame should be 
hung with a counter weight and latch for easy and quick 
adjustment to any height. 

11. A stethoscope for listening to heart and lung 
sounds, etc. (Fig. 17). Camman's binaural is a suitable 
instrument. The soft rubber bell, B, is useful at times 
to secure perfect coaptation to the surface of the chest. 
It requires some practice to secure all the advantages 
that a stethoscope can give, as the pressure of the nib in 
the ear is a distraction of the attention, and any slight 
movement of the fingers on the instrument causes vibra- 
tions that are not understood. If the examiner wishes 
to hear the valvular sounds of the heart, without the 



28 



Records a?id Instruments. 



interference of muscular vibration sounds, he can inter- 
pose a thin cloth between the bell and skin, but in gen- 
eral the instru- 
ment should be 
placed directly 
against the sur- 
face of the body. 

TheAlbionSteth- 
oscope (Fig. 1 8) 
is considered by 
many prominent 
teachers in phys- 
ical diagnosis supe- 
rior to Camman's 
in some respects, 
and more desirable 
because it can be 
conveniently car- 
ried in the pocket 
without detaching 
the tubing. 

In addition to 
the above men- 
tioned instru- 
ments the follow- 
ing are useful at 
times and for 
special work : 

12. A sphygmo- 
graph, or kymo- 
graph, for taking 
pulse tracings. 
Dudgeon's instru- 
ment is perhaps 
as satisfactory as 




Records and Instruments. 



29 



any. It is small, easily 
applied, can be carried 
in the pocket and used 
in the gymnasium as 
well as in the office. It 
cannot be applied to all 
pulsating surfaces. Ma- 
rey's instrument is used 
to some extent, but the 
pneumatic kymograph 
is employed in all physi- 
ological laboratories, 
and does very satisfac- 
tory work. 

13. A laryngoscope, 
rhinoscope, otoscope 
and tuning fork, for ex- 
amining the throat, nose 
and ears. 

14. A Clinical ther- 
mometer. 

15. A Pleximeter and Percussor (Figs. 19 and 20). 

16. A Microscope of 20 mm. focal distance for examin- 
ing the skin. 

17. A case of urinary tests for sugar and albumen. 




&m 



Fig, 17. 



18. Test worsteds, glasses and charts, for examina- 
tion of eyes for color blindness and errors of refraction. 



3° 



Records and Instruments. 



These instruments can be obtained of any first-class 
dealer in surgical instruments and optical goods except 
17, which can be obtained of Parke, Davis & Co., or 
other manufacturing chemists and druggists. 




Fig. i 

The historical data that should be gathered at each 
examination are of varied character, and of the highest 
importance. It not only gives the examiner an idea of 
the immediate weaknesses that are to be met and com- 
bated by proper advice and training, but 
it places the law of heredity in bold relief, 
and enables the counsel to be far-reaching 
in its results. 

For instance: with a record of tubercu- 
losis, extending through two or more gen- 
erations, there would 
seem to be sufficient 
warrant for advising 
not only the thorough 
development of the 
chest, but the careful avoidance of exces- 
sive exercise, such as would be required 
in many athletic sports that would seem, 
at first thought especially suitable for a 
person of consumptive diathesis. To know 
a man well you must know his father and 
grandfather. Fig. 20. 




Fig. 19. 




Records and Instruments. 31 

Growth and organic perfection are gained only by a use 
of all the tissues — but use is one thing and abuse quite 
another. The eye is developed and improved by a 
repeated use in distinguishing colors, shapes and sizes ; 
but a long-continued strain of the eyes over a Greek or 
German text is not exactly beneficial, as the spectacle- 
mounted noses of our students, especially the Germans,, 
bear witness. So, while a good run in the open air may 
be beneficial to a person of sensitive or weakened lung- 
tissue, it does not follow that training for a mile run or a. 
"hare-and-hounds" chase would be. 

The condition of the subject during the previous years: 
of his life is valuable in making a prognosis or a judg- 
ment of the future history of the case, and in deciding 
what quality of endurance the subject possesses, for the 
violent exercise of one man is a mere nothing for 
another. The boy who comes to school from the farm 
or workshop may be no better developed than his class- 
mate who has never known what physical work is, and 
yet be able to endure twice as much prolonged physical 
exertion. His life has been spent out of doors, and he 
takes kindly to out-door sports, running, foot-ball, boating, 
etc. ; or, if his life has been in a shop where skilled man- 
ipulation has engaged his energy, he prefers gymnastic 
exercises, becomes an adept at club swinging, fencing, 
etc. , or a good performer on the bars, rings and other 
apparatus. 

The city-bred boy has a latent aptitude for anything, 
and with proper training is a strong competitor with his 
country classmate in every line of athletics or gymnas- 
tics, but his exercise will need to be progressive or he 
will suifer from local strains that may affect vital organs. 

If, on the other hand, the history discloses a previous 
life of activity and physical hardship, and the plan of 
life is directed toward sedentary pursuits, the recommen- 



32 Records and Instruments. 

dation must be toward retrogressive exercise. A man 
with benign hypertrophy of the heart is not in the best 
condition for sitting at a desk all day — there will be too 
much local congestion for good brain work, or the met- 
amorphosis of muscular tissue in the heart itself will 
end in fatty degeneration, or softening, and impaired 
A r itality result. This is undoubtedly the reason for the 
numerous cases of functional and organic diseases of the 
heart that are found among ex-champions. 

The history may al so disclose a tendency ' to disease in 
the subject that will modify the prescription of exercise 
very materially, if the examiner is alive to the exigencies 
of the case and informed as to its requirements. 

On the record book, in connection with the measures, 
the subject's name and birthplace should be kept — there 
is no reason for secrecy about these matters. It is also 
well to add the birthplace of parents and grandparents 
to this general record, for it makes the material valuable 
in studying the effect of location or environment in dif- 
ferentiating classes or social groups ; the occupation of 
the father, the resemblance in physical build to father's 
or mother's family; past exercise in work and recreation, 
pulse rate, color of hair and eyes, vision and hearing, use 
of tobacco and stimulants. In the private book should 
be recorded the cause of death of either parent if not liv- 
ing, any disease that has been common in the family (it 
is better not to use the word hereditary in this connec- 
tion), such as lung diseases, heart diseases, rheumatism, 
neuroses, Bright 's disease, cancer, scrofula, varicose veins, 
dyspepsia, diarrhoea, constipation, catarrh, etc. ; also any 
disease that may be found affecting the subject, as vari- 
cocele, rheumatism, synovitis, etc., any deformity and its 
cause, if discoverable ; any injury in the way of broken 
bones, surgical operations, strains, etc. ; any previous 
severe illness, such as peritonitis, zymotic fevers, etc. ; 



Records and Instruments. 33 

any tendency to deranged functional activity, as consti- 
pation, biliousness, indigestion, insomnia, etc. 

In this connection it may be well to call attention to 
the rule that, if a child strongly resembles in physical 
build the side of the family that has no hereditary taint, 
the other side having some pathological diathesis or dys- 
crasia, the probability of his inheriting the disease is 
diminished. 

It is well to record the special kind of athletic or gym- 
nastic work that' has been taken and whether this has 
been under the personal direction of a teacher or trainer. 

If there is any lesion of the heart or other organs that 
has been due to or been attributed to athletic or gym- 
nastic work under supervision, look up the instructor and 
get the previous history of the case. You may find that 
the so-called instructor or trainer was an ex-prize fighter 
or dilapidated "bummer," but, if so, use him to discredit 
the popular trust in ignorance. If he does know his bus- 
iness, he will perhaps be able to enlighten you as to the 
cause of the trouble. 

It would seem to. be desirable to establish some general 
system of marking physical condition so that a man who 
had been properly examined could have a statement, in 
such common terms as could be understood by lay people 
anywhere, that should give his condition of [health, the 
important items of his size, the condition of all his so- 
called vital organs, his strength and apparent working 
capacity as well as his probability of life. Francis Galton 
has called attention to this desideratum in a communica- 
tion to the American Association for the Advancement 
of Physical Education (see report 1891). I believe this to 
be a perfectly feasible matter and would suggest in con- 
nection with a graphic and numerical statement of size 
that there be a more extended system of strength tests. 

An arbitrary numerical mark could be given to repre- 



34 



Records and Instruments. 



sent the heredity, the condition of heart, lungs, digestive 
organs, kidneys, nervous system, skin, visual organs, 
hearing, etc. If these were all marked on a scale of ten, 
which should represent perfect condition, lower num- 
bers representing comparative deviations from this stan- 
dard, a comprehensive view would be given of the 
mechanical conditions which tend to make a durable as 
well as satisfactory machine, for from one point of view 
man may be truly considered as a machine. These points 
suggested above might well be divided into two classes 
and marked "essentials" and "desirables." Under 
essentials might he placed the condition -of the heart, 
lungs, kidneys, and nervous system. The other items 
might be classed as desirables but where slight devia- 
tions from perfect condition could be tolerated. A 
report of this kind would be of high value to an employer 
who might be seeking a permanent helper in any line of 
work. 



CHAPTER III. 

WHAT TO MEASURE AND HOW TO MEASURE. 

In making a physical examination and measurement it 
is well to have the subject entirely nude, and conse- 
quently the temperature of the room must be kept as 
high as 75 . During the measurement the examiner 
should be alert in noticing any peculiarity, or deformity, 
or disease, or external indication of disease. The subject 
may then dress the lower extremities and the minute 
examination of the chest be continued. 

When the examination is made for an institution, and 
is to include the measurement of many men, the services 
of a clerk will save at least half of the time and leave the 
examiner free from merely clerical work, and enable him 
to give all his attention to the examination in hand. 
With such assistance the fifty measurements can easily 
be made, after a little experience, in five or six minutes, 
and from fifteen to twenty minutes should be devoted to 
each individual ; the latter amount if advice in regard 
to methods and forms of exercise, and instruction con- 
cerning diet, bathing, sleep, etc. , is to be given at the 
time of the measurement. To economize time the spe- 
cially weak or undeveloped parts should be pointed out 
to the subject himself, and the simplest exercises for 
developing those parts be recommended and illustrated 
if possible at a subsequent meeting. 

A greater advantage will come from exercise if the 
object of the exercise is known than if a routine is simply 
followed without interest. A muscle will undoubtedly 
grow faster if watched and made the object of thought 



36 What to Measure and How to Measure. 

during its activity, and if attention is turned to it during 
its period of rest. The reason of this is found in the 
inter-relation of the trophic and voluntary nerves. 

The hygienic instruction can be given by lecture to 
whole classes, and a case needing special care and super- 
vision can be asked to come to your office at some other 
hour when you will have time to go over the case thor- 
oughly and examine into all the details of his habits, a 
knowledge of which will alone enable you to give the 
best advice. 

If you are examining many cases in succession you 
will need to possess a quick memory of faces and facts 
or some notes will have to be taken at the time of exam- 
ination that will recall the existing conditions in each 
case. It is well to train the memory in this matter, but 
take careful notes to fall back upon. A client will 
feel that you remember him and have given his case 
thought if you can show him that you know just what his 
condition was when you saw him last. 

The number of items measured is not of so much 
importance as the thoroughness of the work done and 
the care and judgment displayed in discovering weak 
parts that can be strengthened, and recommending the 
proper remedies. But I would advise a strict adherence 
to the advanced standard of measurements recommended 
by the American Association for the Advancement of 
Physical Education and for three reasons: 1st, to take 
this complete list would require only about two minutes 
longer time than for the method of twenty items. 2d, 
the completeness of the record will be a satisfaction to 
all parties. 3d, uniformity of methods is of great impor- 
tance in giving scientific value to work of this kind. 

Then, if a person has a special desire to ride some hob- 
by of his own and take such measurements as the hori- 
zontal length, the occipito-mental diameter of the head 



What to Measure and How to Measure. 



37 



and the length of the os calcis, all of which points are of 
some importance and have a bearing on anthropology 
and practical anthropometry, he is at liberty to do 
so 

The following technique of measuring is suggested as 
one that has been found to be the most economical in time 
and energy, and most likely to 
give correct interpretation of the 
physical proportions. 

First secure the height record 
as follows: Place the subject in 
an easy erect standing position, 
with heels together; then step 
behind him and place the foot of 
the pole (Fig. 21) near the heels 
in the median plane and bring 
it to a perpendicular position, 
holding the parts firmly together 
with the left hand. With the 
right hand bring the movable 
hand of the caliper down upon 
the top of the head. Remove 
the pole and read the number 
indicated, as you wish to have it 
recorded by the clerk. There will 
be a tendency on the part of the 
subject to put himself in an unnat- 
ural position, and while it is essen- 
tial for the person to hold himself 
perfectly erect it is desirable for 
him not to stretch himself into unusual positions. If a per- 
son does stretch himself unduly it is well for the exam- 
iner to move him one or two steps before taking his 
height. This puts him off his guard and enables the 
examiner to secure his normal height record, or the sub- 







Fig. 21. 



38 What to Measure and Hoiu to Measure. 

ject may be moved to one side with the same result. 
The method of taking heights by placing persons against 
the wall is faulty, as is also the stretching a person 
against a fixed pole, for the reason that it gives an abnor- 
mal poise. The ordinary standing height of persons with 
deep lumbar curve will increase by 20 to 30 mm. byliaving 
him stretch against a fixed support. The time of day 
when the measurements are taken also modifies the 
reading to some extent, the total height being greater in 
the morning by some 10 to 18 mm. This is due to the elas- 
ticity of the intervertebral cartilages and improved tone 
of the muscles that carry the body erect. A series of 
careful experiments, extending over a year, have been 
made by Mr. F. H. Curtiss, of Purdue University, on 
three young men to discover the loss of weight, and 
gain in height, during sleep. The ages of the young 
men were approximately 17, 19 and 20 years at the begin- 
ning of the observations. His results are as follows : 







Weight 


Loss 


Height 


Gain 




Age 


(Kg.) 


(Kg.) 


(Mm.) 


(Mm.) 


E. 


17 


56. 


•32 


1698 


16.3 


J- 


19 


55-5 


•33 


I723 


18. 


F. 


20 


62.7 


•39 


1680 


18.8 



Next step in front of the person, placing the foot of 
the pole in the median line and slightly in front of the 
line connecting the tips of the toes. Bring the pole to a 
perpendicular position so that the movable arm will rest 
in the sternal notch and read the record. If the height 
of navel is seen to be more than one meter push the slid- 
ing arm up above the head and place the pole near 
enough to the body so that it will touch the abdominal 
wall when perpendicular, then read (Fig. 22). If the 
height be less than one meter use only the upper part of 
the pole placing the end of it on the floor and measure 
as before. 






What to Measure and How to Measure. 



39 



The height of the pubic arch is read from the pole 
while in this same position. In these two measures it is 
not necessary to use the sliding arm of the pole although 
this may be done by reversing the pole and then read- 
ing to the upper edge of the slide, instead of the lower, 
in order to compensate for the thick- 
ness of the fixed arm that will lie 
between the floor and the beginning 
of the graduation. 

All records to this point are to be 
taken without having the subject 
move from the original position. 

Next have the person sit on a stool 
provided for this purpose, which 
should vary in height^ according to 
the general height of the group to 
be measured, the essential point be- 
ing to have the thigh horizontal when 
the person is sitting. For fairly ma- 
ture subjects this will be about 35 
cm., and less for children. Stand- 
ing behind the person place the lower 
end of the upper half of the pole 
upon the top of the stool and bring 
the slide down upon the top of the 
head (Fig. 23). Care should be taken 
to see that the subject is sitting per- 
fectly erect and that the poise of the 
head is correct, as undue elevation or 
depression of the chin seriously modifies the record. 

Take the height of the knee by stepping to either side 
and placing one hand upon the top of the knee so that 
the thumb shall press firmly into a notch found at the 
top of the fibula, and holding the rod in the other hand 
perpendicularly, bring the sliding arm up under the tip 




4° 



What to Measure and How* to Measure. 







Fig. 24. 



of the thumb and read 
(Fig. 24). There seems 
to be no reason for not 
making this a bone meas- 
urement, as it is a length 
of bony structure that is 
sought. The most con- 
venient land - mark for 
measuring seems to be the 
top of the head of the fibu- 
la, this being on the out- 
side of the leg, and on a 
level with the articular 
surface of the joint and 
with the upper edge of the 
biceps tendon. It is, 
therefore, easily found in 
all cases. 

The top of the patella 
has been used as a land- 
mark by some examiners 
and also a measurement to the 
top of the knee. It is obvious 
that neither of these records give 
the true length of the leg for com- 
parison with the length of the 
thigh. 

It is convenient now to take the 
length of the feet, and the pole is 
applied on the inner side of the 
foot as it rests on the floor so that 
its fixed arm rests against the 
greater prominence of the os calcis, 
the pole touching the inner sur- 
face of both the heel and the ball 







What to Measure and How to Measure. 



4i 



Fig. 2= 



of the foot (Fig 25). This saves hand- 
ling the foot and insures uniform accu- 
racy. 

The subject now stands and the 
length of the arm from shoulder to 
elbow is secured by placing the fore- 
arm against the chest in a horizontal 
position (Fig. 26). The pole is applied 
against the front of the arm with the 
fixed arm of the caliper resting on the 
acromion process ; the sliding arm is 
moved up against the olecranon process. 

The length of finger tip is next 
secured by placing 
the fixed arm of 
the caliper against 
the olecranon tip 
and letting the rod 



lie along the back of the forearm. 
Then bring the slide against the tip 
of the middle finger. Care must be 
taken not to apply the rod in such a 
way that the fixed arm of the cal- 
iper rests against the triceps muscle, 
but essentially at right angles to the 
humerus. There appears to be no 
adequate reason for taking the length 
of both right and left arm. 

The stretch of arms may next 
be taken by grasping the upper 
end of the lower half of the pole, 
and by applying the other end 
of it to the wall about the height 
of the shoulder of the subject, 
and directing him at the same 






Fig. 26. 






4 2 



What to Measure and How to Measure. 



time to put the tip of his finger against the wall at the 
same place. While he is doing this bring the second 
part of the rod to position so that when you ask him to 
extend the other arm you have everything in position, 
so that you may readily move the slide against the tip of 
his middle finger while he is in a position of complete 
extension. 

Now lay aside the lower half of the rod and take 
breadth measurements, beginning with breadth of head. 
This and the next three records should be taken stand- 
ing behind the person. In taking all breadths care 

should be taken to hold the rod 
so that the sliding arm may be 
moved by the right hand. 
Press the caliper firmly at a 
point high enough to ins are 
including the broadest part of 
the skull then lower until it 
touches the tops of the ears. 
The widest part will have 
been included. 

Great care must be exercised 
in securing the breadth of neck 
FlG - 2 7- as the tissue is extremely sus- 

ceptible to change under pressure. Measurements should 
be taken from behind with the left hand resting on the 
left shoulder of the subject in such a way that the thumb 
and forefinger can bring the fixed arm of the caliper to 
touch the left side of the neck (Fig. 27). The thumb of 
the right hand can then move the sliding arm of the cali- 
per up to touch the right side of the neck and the correct 
breadth be thus secured. 

I see no reason why the breadth of shoulders should 
not be taken at the level of the acromions, and have 
always so taken it. This accounts for the difference in 




What to Measure and How to Measure. 



43 



records shown on the percentile charts of Amherst and 
Yale students. The subject should stand in easy posi- 
tion without throwing the shoulders back (Fig. 28). 

The technique should obviously be the same for taking 
breadth of waist as for securing the breadth of the neck 
•except that the left hand should rest upon the hip 
instead of the shoulder. The record should be taken at 
the narrowest part of the trunk or over the last rib. 

After taking breadth of waist pass in front of the sub- 
ject and measure the breadth of chest by placing the tips 
of the caliper in the axil- 
lary spaces at the level 
of the nipples, taking care 
not to place them so far 
back as to include any 
part of the latissimus 
muscle. The breadth of 
nipples should next be 
taken from center to 
oenterif measured at all. 
I perceive no adequate 
reason for making this 
record. The breadth of 
nips should next be 
measured by pressing the 
caliper arms firmly against the trochanters, as this should 
be a bone measurement. It may be well to note that 
the height of this diameter is the height of pubis. 

In recording the measurements of women it is advis- 
able to measure also the breadth of the hips at the pelvic 
crests. This can be done without including muscular 
tissue by applying the tips of the caliper arms to the 
outside of the anterior superior spinous processes of the ilii. 

The measuring pole may now be laid aside and the 
caliper for depths used. In taking depths care must 




44 



What to Measure and Now to Measure. 



be exercised to secure the normal position of the 
subject, as slight muscular movements change the depth 
greatly. The depth of chest is taken by applying one 
foot of the caliper to the spinous process, and the other to 
the sternum on a line between the nipples in such a way 
that the plane of the caliper will lie at right angles to the 
axis of the spine (Fig 29). The caliper must be so con- 
structed that a spring shall hold the caliper arms against 
the chest with a constant tension, and a pointer affixed to 
one arm moving along the graduated arc will indicate 
the antero-posterior movements of the sternum during 
respiration and the maximum 
reading indicate the depth of chest 
at ordinary inspiration. The depth 
of the abdomen is next secured 
with the caliper in the same rela- 
tive position to the spine, and 
the anterior arm resting slightly 
above the navel. This record 
is valuable only in a general way. 
The author believes . that 
in all cases where there is 
obvious asymmetry of the chest, 
or where there is found pul- 
monary disease or bone deformity, it is well to take 
other depth measurements as well as those prescribed by 
the American Association. The depth of right and left 
sides may well receive consideration, and their record 
may be taken at various heights and at indifferent 
phases of respiration for private records. 

The girth measurements should next be taken. It is 
convenient to begin with girth of head, which should be 
taken around the largest part and ever frontal and occi- 
pital prominences. The tape may be conveniently 
applied by holding it between the thumb and forefin- 




What to Measure and How to Measure, 45 

ger of each hand, with the hands at such a distance from 
each other that they shall represent about the distance to be 
measured (Fig. 30). The tape thus extended should be lifted 
<over the person's head with the examiner standing at the 
right of the subject; the hands to be raised or lowered as 
may be necessary to bring the line of tape into conjunc- 
tion with the greatest diameter, which may be readily 
appreciated from this position. After reading the tape in 
position it should be lowered to the neck and the record 
secured by measuring around the smallest part just below 
the larynx. It will be noticed in carefully observing the 
contour of the 
neck that there 
is usually a small- 
est part, the 
neck being 
formed essential- 
ly by two trun- 
cated cones ap- 
plied to each 
other. 

The tape is now 
removed from the 
neck and applied 
to the chest under the arms in such a way as to have the 
unit end lie upon the right half of the chest in front. 
The tape should embrace the lower ends of the scapulae 
and lie 2 cm. above the nipples. It is convenient to 
record first the normal chest. (It need hardly be said 
that no girth measurement should be taken with the finger 
under the tape, but the author has seen this done by 
people of some little experience, especially in taking 
chest measurements.) Then without moving the tape 
have the subject inhale and expand the chest to its great- 
est capacity, the tape meanwhile to be removed from the 




46 What to Measure and How to Measure. 

front wall by raising- the ends of the tape so as to allow 
free play during expansion. After the reading is made 
have the subject exhale, flattening the chest as com- 
pletely as possible. Apply such tension to the tape as 
shall keep it against the skin, but care must be taken 
that no greater tension is applied to the tape during the 
time of reading the record for contracted chest than for 
expanded chest, as will be the tendency. The girth of 
chest should then be taken below the pectoral muscle 
about 8 cm. below the nipple in both forced inspiration 
and expiration. This is usually called the girth at the 
ninth rib, the tape crossing the ninth rib in the axillary 
space. 

The girth of waist should be measured around the 
smallest part of the trunk. 

Care must be taken in securing this record that the 
subject does not contract the abdominal muscles and 
thereby diminish the normal size of the waist. If the 
subject does this I would advise the examiner to pass 
the tape line down and secure the girth of hips, then 
secure girth of waist, which will then be found usually 
in normal form. 

In measuring girth of hips the tape should pass hori- 
zontally over the greatest protrusion of the gluteal mus- 
cles, the subject standing with heels together as in 
heights and breadths. After the tape has been put 
around the trunk for the first chest measurement it 
should not be removed until the girth of hips is read. 

It is convenient now to begin the measurement of the 
limbs, and the subject should stand with the feet about 
15 cm. apart with the weight borne equally upon 
them. 

Beginning with the right biceps place the tape around 
the largest part, in a plane at right angles to the axis of 
the humerus, while the muscle is strongly flexed. The 






What to Measure and How to^ Measure. 



47 



irm is then straightened and the tape placed midway 
between the ends of the humerus for girth of arm (Fig. 31). 

The position of the greatest enlargement during the 
contraction varies greatly in different people, being 
dependent on the relative lengths of the tendonous por- 
tions. It seems desirable that we should have a record 
for both biceps and arm, as a relative size of these two 
records gives a strong indication of the muscular condi- 
tion of the subject, for if the size be largely made up of 
fatty tissue, the difference between the two records will 
be comparatively small. 

The girth of elbow is 
supposed to indicate to 
some extent the bony de- 
velopment of the subject, 
if measured around the 
condyles. However, this 
record is always found 
to be large if the girth 
of the forearm be large, 
since the measurement 
must of necessity include 
heads of both flexors and 
extensors of the forearm, 
and these are the muscles that are 
their largest parts in the forearm. 

I prefer to have this girth indicate the extent to which 
the tissues of the arm extend to and coalesce with the 
tissue of the forearm. Consequently I measure above 
the internal condyle around the smallest part of the arm. 
The difference in the two methods is shown on the per- 
centile tables from Amherst and Yale students (see 
Figs. 43 and 48). 

The tape is next lowered to the largest part of the 
forearm, while the hand is tightly closed, and the girth 




Fig. 3T. 

measured 



over 



48 What to Measure and How to Measure. 

recorded. It is then lowered to the smallest part of the 
wrist, i. e., below the styloid process, while the thumb is 
kept well in toward the palm. 

The thigh is next measured close to the gluteal curve 
and the tape then lowered to the knee over the center 
of the patella. The girth of calf is taken around the 
largest part ; the ankle around the smallest part. The 
tape is then removed and placed around the instep over 
the tarso-metatarsal joint. The left side is then meas- 
ured in the same order. The examiner stands at the 
side of the subject while securing these limb measure- 
ments, rather than in front (see Fig. 24). 

Below is given in full the report of the committee on 
statistics appointed by the American Association in 1885 : 

Report of the Committee on Statistics, appointed by the 

American Association in 1885, giving the detailed 

method of securing measurements, tests, and 

the condition of the human body. 

ANTHROPOMETRIC MEASUREMENTS. 

Number. — In order to secure privacy the individual 
should be entered in the record book by number. As a 
means of identification the number can be entered in an 
alphabetical index book opposite the corresponding name, 
as: 

Smith, John H., 526. 

For further convenience it is advisable to enter the 
name in a numerical index book opposite the correspon- 
ding number, as : 

526, John H. Smith. 

Date. — Record the year, month, day and hour, as: 
Jan., '86, 12, 9 A. M. Where perfect accuracy is desired, 
note should be made of the time that has elapsed since 
eating, the occupation of previous hours, and of the tem- 
perature of the room. 



What to Measure and How to Measure. 49 

Age. — Record years and months, as: 21, 9, i. e. r 
twenty-one years and nine months. 

Weight. — The weight of the body should be taken 
without clothes. Where this is impracticable the weight 
of the clothes should be deducted. 

Height. — The height should be taken without shoes, 
and with the head uncovered. The head and figure 
should be held easily erect, and the heels together. This 
position is best secured by bringing the heels, the but- 
tocks, the spine between the shoulders and the back of 
the head, in contact with the measuring rod. 

Height of Knee. — The subject should place one foot 
on a box or chair of such a height that the knee is bent 
at a right angle. A box about twelve inches high is 
suitable for adults. Press a ruler upwards with a force 
of about one pound against the ham string tendons close 
to the calf of the leg. See that the ruler is held in a posi- 
tion at right angles to the vertical rod, and measure the 
height of the top of the ruler from the box. 

Height Sitting. — Let the subject sit on a hard, flat 
surface about twelve inches high, such as afforded by a 
box or chair, with the head and figure easily erect so 
that the measuring rod will touch the body at the but- 
tocks between the shoulders, and at the back of the head. 
Measure the distance from the box to the vertex. 

Height of Pubes. — With the subject .standing easily 
erect on the box or floor measure up to the lower edge 
of the pubic bone. 

Height of Crotch. — With the subject standing easily 
erect on the box or floor facing the vertical rod, press a 
ruler firmly against the perineum (crotch) and measure 
the height of the top of the ruler. 

Height of Navel. — With the figure and head of the 
subject erect, measure the height of the center of the 
cicatrix. 



50 What to Measure and How to Measure. 

Height of Sternum. — With the figure and head of the 
subject erect, measure the height of the interclavicular 
notch. 

All girths should be made on the skin itself at right 
angles to the axis of the body or limb at the point of 
measurement. No oblique measurements are taken. 

Girth of Head. — This measurement should be taken 
around the head with the tape at the upper edge of the 
eye brows, over the supra orbital and occipital promi- 
nences. 

Girth of Neck. — With the head of the subject erect, 
pass the tape around the neck half way between the head 
and body, or just below the "Adam's Apple." 

Girth of Chest. — Pass the tape around the chest so 
that it shall embrace the scapulae and cover the nipple. 
The arms of the subject should be held in a horizontal 
position while the tape is being adjusted and then allowed 
to hang naturally at the sides. Take the girth here 
before and after inflation. 

Where it is desirable to test the elasticity or extreme 
mobility of the walls of the chest, a third measure- 
ment may be taken after the air has been forced out and 
the chest contracted to its greatest extent. To test the 
respiratory power, independent of muscular development, 
pass the tape around the body below the pectoral line 
and the inferior angles of the scapulae, so that the upper 
edge shall be two inches below the nipples. Take the 
girth here before and after inflation. 

Girth of Waist. — The waist should be measured at 
the smallest part after a natural expiration. 

Girth of Hips. — The subject should stand erect with 
feet together. Pass the tape around the hips above the 
pubes over the trochanters and the glutei muscles. 

Girth of Thighs. — With the feet of the subject about 
six inches apart, the muscles set just enough to sustain 



What to Measure and How to Measure. 5 1 

the equilibrium of the body and the weight distributed 
equally to each leg, in gluteal fold measure around the 
thigh just below the nates. 

Girth of Knee. — With the knee of the subject 
straight and the weight of the body equally supported 
on both legs, measure over the center of the patella. 

Girth of Calf. — With the heels down and the weight 
of the body supported equally on both feet, the tape 
should be placed around the largest part of the calf. 

Girth of Instep. — Measure around the instep at right 
angles with the top of the foot, passing a point at the 
bottom of the foot midway between the end of the great 
toe and back of the hee\ 

Girth of Upper Arm. — With the arm of subject bent 
hard at elbow, firmly contracting the biceps and held 
away from the body in a horizontal position, pass the 
tape around the greatest prominence. If desirable to 
find the girth of the upper arm when the biceps is not 
contracted, the arm should be held in a horizontal posi- 
tion and measured around the most prominent part. 

Girth of Elbow. — Taken around the internal condyle 
of the humerus while the arm of the subject is straight, 
with the muscles of the forearm relaxed. 

Girth of Forearm. — Taken around the largest part. 
The fist should be firmly clinched and the palm of the 
hand turned upward. 

Girth of Wrist. — With the hands of the subject open 
and the muscles of the forearm relaxed, measure between 
the styloid process and the hand. 

Breadth of Head. — The breadth of head should be 
taken at the broadest part. In taking the breadth meas- 
urements, stand behind the subject. 

Breadth of Neck. — Taken at narrowest part with the 
head of the subject erect and the muscles of the neck 
relaxed. 



52 What to Measure and How to Measure. 

Breadth of Shoulders. — With the subject standing- 
in a natural position, elbows at the sides, shoulders 
neither dropped forward nor braced backward, measure 
the broadest part two inches below the acromion processes. 

Breadth of Waist. — Taken at the narrowest part. 

Breadth of Hips. — Measure the widest part over the 
trochanters, while the subject stands with feet together, 
the weight resting equally on both legs. 

Breadth of Nipples. — Taken from center to center 
with the chest in a natural position. 

Depth of Chest. — Taken after a natural inspiration. 

Place one foot of the calipers on the sternum midway 
between the nipples, and the other foot on the spine at 
such a point that the line of measurement is at right 
angles with the axis of the spinal column. When it is. 
desirable to ascertain the extent of the antero-posterior 
movement of the chest, measurements may be taken 
from the same points after the fullest inspiration and 
after the fullest expiration. 

Depth of Abdomen. — Place one foot of the calipers 
immediately above the navel, the other on the spine at 
such a point that the line of measurement is at right 
angles to the axis of the spinal column. 

Length of Shoulder to Elbow. — With the arm of 
the subject bent sharply at the elbow and held at the 
side, measure from the top of the acromion process to 
the olecranon. Care should be taken that the measuring- 
rod is parallel with the humerus and not with the exter- 
nal surface of the arm. 

Length from Elbow to Finger Tip. — With the arm 
of the subject bent sharply at the elbow and the rod 
resting on back of arm and hand, measure from the ole- 
cranon process to the tip of the middle finger. 

Length of Foot. — Take the extreme length of foot 
from the end of the first or second toe to the back of the 



What to Measure and How to Measure 



53 



heel, about one inch from the surface upon which the 
foot rests. 

Stretch of Arms. — With the arms of subject stretched 
out horizontally so that both hands and shoulders are in 
a line, with one middle finger and the zero end of the 
measuring- rod pressed against the wall, note the point 
to which the other middle finger tip reaches. 

Horizontal Length. — With the heels of the subject 
pressed hard against a perpendicular wall, with arms at 
the sides and body resting naturally on a horizontal 
plane, measure the distance of the apex of the head from 
the wall. 

Capacity of Lungs. — The subject after loosening the 
clothing about the chest and taking a full inspiration, fill- 
ing the lungs to their utmost capacity, should blow 
slowly into the spirometer. Two or three trials may 
be allowed. 

Expiratory Strength. — As before, the subject after 
loosening the clothing about the chest and filling the 
lungs completely, should blow with one blast into the 
manometer. Care should be taken that no air is allowed 
to escape at the sides of the mouth, and that in expelling 
the air all the muscles of expiration are brought into play. 

Strength of Back. — The subject, standing upon the 
iron foot-rest with the dynamometer so arranged that 
when grasping the handles with both hands his body will 
be inclined forward at an angle of 6o°, should take a full 
breath and, without bending the knees, give one hard 
lift, mostly with the back. 

Strength of Legs. — The subject while standing on 
the foot-rest with body and head erect, and chest thrown 
forward, should sink down, by bending the knees, until 
the handle grasped rests against the thighs, then taking 
a full breath he should lift hard, principally with the 
legs, using the hands to hold the handle in place. 



54 What to Measure and How to Measure. 

Strength of Chest. — The subject with his elbows 
extended at the sides until the forearms are on the same 
horizontal plane and holding the dynamometer so that 
the dial will face outward and the indicator point upward, 
should take a full breath and push vigorously against 
the handles, allowing the back of the instrument to press 
on the chest. 

Strength of Upper Arms, Triceps. — The subject, 
while holding the position of rest upon the parallel bars, 
supporting his weight with arms straight, should let the 
body down until the chin is level with the bars, and then 
push it up again until the arms are fully extended. Note 
the number of times that he can lift himself in this man- 
ner. 

Strength of Upper Arms, Biceps. — The subject should 
grasp a horizontal bar or pair of rings and hang with 
the feet clear from the floor while the arms are 
extended. 

Note the number of times that he can haul his body up 
until his chin touches the bar or ring. 

Strength of Forearms. — The subject, while holding 
the dynamometer so that the dial is turned inward, 
should squeeze the spring as hard as possible, first with 
the right hand then with the left. The strength of the 
muscles between the shoulders may be tested with the 
same instrument. The subject, while holding the dyna- 
mometer on a level with the chest, should grasp it with 
handles and pull with both arms from the center 
outward. 

Pilosity. — Note the amount of hair on the body and 
limbs, excluding the head, face and pubes. 

• Color of Hair. — Light (Very Fair, Fair, Light Brown, 
Brown), Dark (Dark Brown, Black Brown, Black). Red 
(Red Brown, Red, Golden). 

Color of Eyes. — Light (Dark Blue, Blue, Light Blue). 






What to Measure and How to Measure. 5 5 

Dark (Light Brown, Brown, Dark Brown, Black). 

Mixed (Gray, Green). 

D. A. Sargent, ] 

Edw. Hitchcock, >- Committee. 

Wm. G. Anderson, J 

The following criticisms of this Report, that now 
stands as the official list of the Association, are presented : 

The height of knee should be a bone measurement, 
and the most convenient point is to top of the fibula, as 
the subject is sitting, and this record can be taken imme- 
diately before or after "height sitting." The present 
method is very inaccurate and unscientific, because the 
length will vary from two to three cm., according to the 
tension of the hamstring muscles, which are not always 
under the direct control of the will with the leg in the 
position indicated and cannot be relaxed in every case 
without great care. The head of the fibula can be 
easily found in nearly every case, and in those where 
it cannot be located readily the hamstring tendon can be 
found and it runs directly to the point sought. The 
record should be taken to its upper edge. The tibia can 
be found, and the head of the fibula is about 10 mm. 
shorter. The "height of crotch" need not be taken, 
for obvious reasons, when we have "height of 
pubes. " 

Another height-measurement advised by the Y. M. C. 
A. committee is the length of trunk, which is measured 
from the buttocks to the point of the seventh spinous 
process, or vertebra prominens, with the subject in the 
same position as for taking the height sitting. It is not 
always easy to decide with certainty which is the 
seventh spinous process; but it is usually the most prom- 
inent one, and of several that seem of equal prominence, 
it is usually the lowest. 



56 What to Measure and How to Measure. 

The length of trunk, depth of chest and breadth of 
chest are three factors, that, multiplied together, may 
roughly be considered to represent the "vital capacity" 
of a person. We can get the length of trunk in another 
way — by subtracting the height of sternum from total 
height, which will give the length of head and neck; 
and, by subtracting this remainder from the height sit- 
ting we shall have the length of trunk. 

I can discover no adequate reason for taking the 
horizontal length. It consumes considerable time, is 
•a difficult measurement to take correctly, and exceed- 
ingly awkward for the subject: its average relation to 
the total height is a matter of anatomical record, and, 
in the special case it can easily be estimated by any 
examiner, of even limited experience, by the amount of 
lordosis and flexibility of the spine. Each person should 
take a few measurements of subjects with hollow backs, 
in order to get an idea of the variation in these cases ; but 
further than this there is no utility in the recording of 
this item. 

The breadth of shoulders should be a bone measurement 
as nearly as possible ; for I conceive the object of it to be 
the determination of the extent of the bone tissue to 
which the more important muscles of the upper extremi- 
ties and thorax are attached. If we measure below the 
acromion, as directed, we give a person credit for broad 
shoulders simply because he has a thick deltoid muscle 
and the muscles of the chest and arm add to the record, 
in such cases, by making the arm hang at an angle instead 
of perpendicularly, as expected. 

The expiratory strength, as ordinarily taken, is mis- 
leading and untrustworthy. The intention is to gain 
some knowledge of the condition of the accessory mus- 
cles of expiration; for, in ordinary expiration there is 
little or no activity of muscles but rather a letting go or 



What to Measure and How to Measure. 5 7 

suspension of muscular effort. (See Foster. Phys. ed. 
1883, p. 315.) Now, when the subject is asked to blow 
as hard as he can into the apparatus, and keep the throat 
open, as in respiration, he will involuntarily close the 
pharynx with t^e back of the tongue and palate, and 
then bring the muscles of the cheeks and lips into active 
•contraction, and, with a few efforts, acquire such skill as 
to rival the cornet player in the record secured. 

For those who are making a special study of athletes 
a measurement suggested by Dr. Savage of New 
York is worthy of notice, namely, the length of 
the os calcis, this being the lever arm of the muscles 
that extend the foot ; its relation to the metatarsal and 
phalangeal portion is doubtless of importance in deter- 
mining the ability for such exercises as running, walking, 
jumping, etc. 

Some points in minute anthropometry have been sug- 
gested by various specialists, but obviously such work 
should be left to those who wish to study some particular 
phase of the subject. The height of ear, girth of ankles 
and hands, depth of pelvis, neck and head, length of 
"hands, fingers, ears, etc., have all been recorded by 
some observers. 

Dr. Mosher thinks that depth of chest should be a 
•double measurement, showing thickness of right and left 
chest, and the suggestion is a good one, because, in many 
cases the sternum is depressed and the record, if made 
.strictly by rule, would be smaller than the subject 
deserves, and this method would show any asymmetry 
•of the chest. 

The French police regulations require a minute meas- 
urement of the ear and middle finger for identification of 
•criminals if they are arrested a second time. These 
measures help in classifying the photographs that are 
taken so that they can be readily found among thousands. 



5 8 What to Measure and How to Measwe. 

Some form of anthropometrical tests can no doubt be 
made more serviceable in establishing identity in a 
"rogues' gallery" than photography. The physiological 
picture of a man as shown on a graphic chart is sure to 
retain some characteristic feature, whatever ma)' be his 
condition. The imprint of the papillary ridges of the 
thumbs has been shown by Galton to be an efficient 
means of identification. 

Photography may be wisely used as an adjunct of 
anthropometry. Since Prof. Muybridge made his won- 
derful pictures of animal locomotion by instantaneous 
process the value of a photograph to show physical defi- 
ciencies as well as excellence has been established. It 
makes a record in an artistic way that is made by tape 
and calipers in a mathematical or scientific way. 
Already at some of the better equipped gymnasiums 
photography is made to assist in preserving the record 
of a man's physical condition. 

The tests for accuracy and strength may be made by 
the record in a series of athletic exercises and show some- 
thing of the nerve training that the subject has had — in 
other words, the self-controlled power. In a person we 
may test the strength of fifty groups of muscles actings 
separately so far as possible and, while our record may be 
high, we may still have a very inadequate estimate of the 
coordinated power — the real strength of the individual, 
which may be small. Probably the best exhibit of a 
man's power is seen in such games as foot-ball, where the 
strength of every muscle is tested both as to its own. 
quality and its adjustment to other muscular groups and 
to mental stimuli. 

Another refinement of anthropometry is taking the 
specific gravity of a man. This may not be a feasible 
addition to practical anthropometry but for minute study 
may afford an interesting field of investigation. The 



:: to Measure and Hen Me* 59 

record can be taken by immersing the subject to the face 
or any suitable point in a reservoir of water that is situ- 
ated on a scale for weighing. From the weights of the 
reservoir full of water, the displaced water and the 
immersed subject in the reservoir the specific gravity 
has been calculated. The fact has been often noted that 
men of small girths often show a weight far above what 
would be fairly estimated, but as yet there has been no 
scientific study of this class of cases to discover the rela- 
tion of high specific gravity to health, strength, endur- 
ance or longevity. The specific gravity of any body is 
represented by the quotient obtained by dividing the 
weight of the body in air by the loss of weight when 
weighed in water. 

The discovery of the superficial area of a person is of 
some value and may be found by the following formula : 
Surface, in square centimeters. = 11 ^-t*. 



CHAPTER IV. 

PERSONAL HISTORY AND EXAMINATION OF THE 
SPECIAL SENSES. 

In examining young people the condition of the organs 
of special sense becomes a legitimate and important field 
of inquiry and record. Civilized man is as much the 
product of nerve reactions as he is the result of material 
influences that we ordinarily call hygiene — food, air, tem- 
perature, etc. The intellectual working of the brain is, 
in fact, more strongly influenced by defective sense 
impressions than it is by defective nutrition. The 
tinnitus of a diseased ear has driven many a person insane, 
and the nerve strain of an imperfect eye has produced 
the most serious functional diseases of the nervous sys- 
tem.* 

The eyes should be examined by a specialist in ophthal- 
mology if there is the slightest indication of nerve irrita- 
tion, and the superficial examination, such as is indicated 
here, shows the slightest error of refraction or muscular 
insufficiency. 

The record of color-blindness should be kept, not as a 
disease, but as a peculiarity that would render the sub- 
ject unfit for some occupations. In many cases of sap- 
posed color-blindness the sense is probably simply uned- 
ucated. Cases of color-blindness among women are 
very rare (i in 25,000) and are not frequent among men. 

*See the New York Medical Journal for January 7 and 14, 1888, 
and the same journal February 27 and March 13, i836. containing arti- 
cles by A. L. Ranney, M. D. , on The Treatment of Functional Nervous 
Diseases by the Relief of Eye-Strain, etc. Also the Belgian Prize 
Essay, by Dr. Stevens, of New York, and the Report of the Stevens 
Commission, published in The Neurological Journal, 1889. 



Special Senses. 6r 

Among school children and adults who are engaged in 
sedentary occupations requiring the almost constant use 
of the eye it becomes absolutely necessary that the visual 
organ be essentially perfect if the brain is to work with 
its maximum of power for a long period. That the exam- 
ination of the eye is important is proved by the number 
of cases of error of refraction to be found in any group 
and the very complete remedy that is found in properly 
adjusted lenses. 

Dr. Seelye has found that only about twenty-seven per 
cent of the students have normal vision. The following 
table shows the variety and prevalence of errors by per- 
centages : 

Emmetropia. Hyperopia. Myopia. Astigmatism.. 

Amherst - - - 27 44 23 22 

Yale - - - - 42 23 19 35 

N. Y. University - - 57 14 29 

The difference in these results is largely due to the 
standard of working. In the figures from Amherst the 
greatest accuracy exists, as all the tests were made by 
a trained specialist in ophthalmology. 

A few brief definitions of terms used may be of assist- 
ance in understanding the table. By Emmetropia is 
meant normal or perfect vision. All rays of light coming 
from a distant object focus or meet at one point exactly 
upon the retina and form a clear image there. 

Myopia or "near-sightedness" is due to the eye being 
so long from before backwards, that rays of light which 
enter the eye parallel or from a distance come to a focus 
a little in front of the retina and hence an indistinct 
image is formed on the retina. 

In Hypermetropia or "far-sightedness" the eye is too 
short from before backwards, and hence parallel rays 
entering the eye focus behind the retina, and thus the. 
image made on the retina is a blurred one. 



62 Special Senses. 

In Astigmatism the anterior part of the eye is irregular 
in curvature, and therefore rays of light entering in the 
different diameters focus at irregular distances on, in 
front of, or behind the retina, so that the image of the 
object seen is distorted. That is all rays do not focus or 
meet at the same point. 

The following directions are given for testing the re- 
fractive power of the eye and its color sense and also for 
determining the auditory power: 

Procure of any optician two pairs of spectacles, one with convex 
glasses, No. -}- . 75 Dioptric ('^qual to No. 4- 48 in the old or English 
system), and the other with concave glasses. No. —.75 Dioptric. Also 
obtain a copy of Monoyer's test letters (a cam of Dr. Dennett's modi- 
fication of Monoyer's test type may be procured of any optician), to 
be hung up at six meters distance, and a copy of Green's astigmatic 
lines, in the form of a clock face, to be hung up at the same distance. 

Test: — Seat the subject at a distance of six meters from the test 
cards, which should be hung in a good light. Examine each eye sepa- 
rately, keeping the other covered by a card held in front of, but not 
touching it. Never press the fingers against the closed lid. 

There are ten lines of letters on the test card, numbered from .1, .2, 
.3, etc., up to ten ioths or 1. If now the subject can read the top line, 
the smallest letters on the card, with the right eye (R.E.) alone, his 
vision (V.) is recorded as ten ioths or 1. (V.R.E. = 1). If he sees 
nothing clearly above the fifth line from the bottom, but can read that 
correctly, then V.R.E. =.5. If he cannot read any of the lines, then 
V.R.E. is less than one-ioth. Whatever the vision without glasses 
may prove to be, always next put on the convex spectacles and again 
cover the other eye. If now he can still with the right eye see as well 
or better than with no glasses at all, and can read the same line as 
before, he is Hypermetropic (Hy.) in that eye (/. e., far sighted). For 
example, if without glasses it was found that V.R.E. =.5, and now 
after adding the convex glass his V. is improved to .8, the record 
would be V.R.E. =.5 -j-Hy. =.8. But if the vision is neither im- 
proved nor made worse by the convex glass, the record will be thus: 
V.R E.=:.5 -f-Hy.;=.5. if the convex glass can be used at all with- 
out decreasing the vision, no further testing with this card is needed ; 
the subject is hypermetropic in that eye. If it is found that the vision 
of the right eye equals 1. without glasses, and then the addition 
of the convex glasses blurs the letters, the eye is Emmetropic (Em.) 
that is, there is no error of refraction. 



Special Senses. 63 

If, however, the vision without the glasses is less than 1., for in- 
stance only .3, and the convex glasses make even that line more in- 
distinct, then put on the concave glasses If now the vision is im- 
proved so that a higher line can be read, for instance the eighth from 
the bottom, the eye is Myopic, or "near sighted," and the record will 
be V.R.E. =.3 -f- My. = .8 Or again, if the vision without glasses in 
the left eye is found to be . 7 and then with the concave glasses the 
top line can be read, the record will stand thus: V.L.E. = 7 4-My. = i. 
After testing each eye separately, place the record of one above the 
other, for example thus : 

j V.R.E =1. Em. 

\ V.L.E. = .6+My.=. 9 . 

This completes the testing for simple hypermetropia, myopia and 
emmetropia. 

After testing the eyes as above, if the vision has not yet been made 
perfect in either, leave on the proper correcting glass, the convex if 
there is hypermetropia, or the concave if there is myopia, or use no 
glass if there is neither; then direct the subject's attention with that 
eye alone, the other being covered, to the card of radiating black lines. 
If he see one or more of the lines running in any direction clearer or 
blacker than those at right angles to them, he is shown to be astig- 
matic. Either the perpendicular or the horizontal lines usually appear 
the blacker to the astigmatic person. If the previous record was 
V.R.E. =.7 and this defect is found, then it will be V.R E. = .7 +As. 
Or if before it read: V.L.E. =.3 -f My. =.6, and astigmatism is found, 
it will read, V.L.E. = .3 -f-My. = .6 -{-As. Astigmatism may exist 
either alone or in combination with My. or Hy. If alone we might 
have a record thus : V.R E.=.6-(-As.; V.L.E. =.4 + As , or if with 
hypermetropia thus: V.R.E. =.7 -f-Hy.=.7 -{-As. ; V.L.E.=.6 + 
Hy.=.8+As. 

To recapitulate, in brief: if it is found that V.R.E. =1, then the 
R.E. is Emmetropic or Hypermetropic. If emmetropic, the convex 
glass will markedly impair the vision ; if hypermetropic it will not. 
If the V.R.E. =.9 or less, then the R.E. is either hypermetropic, my- 
opic, astigmatic or amblyopic. 

\st. If it is Hy. the convex glass will not greatly impair the vision. 

2nd. If it is My. the concave glass will improve V. 

3rd. It it is As. one of the radiating lines is blackest. 

4//z. If neither of these defects exists and the V. is less than . 7 
then Amblyopia or partial blindness may be recorded. It may read 
thus: V.L.E. =.6 -{-Am. 

Caution. — Always try the convex glass. Never try the concave 



6 4 Special Senses. 

unless the convex glass blurs the vision. Have subject close the eyes, 
when not being tested. 

In the following cases the subject should be recommended to consult 
an oculist concerning the advisability of wearing glasses : If the vision 
without any glasses is less than .4 in either or both eyes; if he com- 
plains of weak, watery or painful eyes, headache, especially in read- 
ing, and any degree of hypermetropia or astigmatism is found to- 
exist ; if the eyes are unlike to the extent of .2. 

Directions for Testing the Color Sense. 

A set of test worsteds of different primary colors and shades, may 
be procured. To make the examination, spread all the worsteds out 
on a white cloth placed upon a table. First lay the green test skein 
a little to one side of the others, and then tell the subject to throw out 
of the pile and lay along side of the test skein all the lighter and 
darker shades of that color, or all the skeins containing a shade of that 
color in any degree. Avoid naming the color "green" to him. If he 
throws out only shades of green or light blues his color sense is 
normal (C.S. N.) and the test is completed. But if in addition he throws 
out light grays, or any other shade of gray, or light yellows, salmons, 
or pinks, he is color-blind. If he handles or fumbles over those shades 
a good deal and hesitates, as if in doubt about them, but yet does not 
throw them out, he probably has "feeble color sense" (C.S.F.). The- 
examiner in these cases must use his judgment in making a certain 
amount of allowance for the stupidity of some persons in understand- 
ing what is wanted, especially in the young and uneducated. 

If the subject is found to be color-blind, next lay down the purple or 
rose-colored test skein, in place of the green, in order to determine the 
nature of the defect. Now tell him to throw out all the different shades 
of that color. If he only throws out pinks and light reds and shades 
approaching these he is only partly color-blind. (P.C.B.). But if he 
throws out decidedly bluish purples, blues, violets, greens, or grays, 
he is completely color-blind. (C.C.B.). Completely red blind if he 
throws out the blues violets, etc. , or green blind if the grays or greens. 

No further testing is needed, but as a matter of curiosity and to 
prove the result, the red test skein may next be tried in the same way. 
If he matches with it browns or greens and grays he is completely 
color-blind. Dark brown or green if red blind, and light brown or 
green if green blind. 

It is not important to record whether the complete color-blindness is 
red or green blindness. The following classes may be recorded : — 
Color sense normal=C.S.N. ; Color sense feeble=C.S.F. ; Partial 
color-blindness=P.C.B. ; Complete color-blindness=C.C.B. 



Special Senses. 65 

Color-blind individuals should be warned against engaging in any 
occupation where this defect would prove dangerous or inconvenient. 

Directions for Testing the Auditory Sense 

Use an ordinary watch and a tuning fork, letter A, or C. as :es:s 
Seat the subject with his right side toward you, and then while the 
room is perfectly quiet, see how far off he can hear the watch tick. 
Having previously learned by a few experiments what is the furthest 
distance at which the tick can be heard by normal ears, make that 
number of inches the denominator of a fraction, and the hearing dis- 
tance of each person examined thereafter the numerator. Having 
found the normal distance (=H.D ) to be, for instance, about sixty 
inches, and that of the subject now examined to be, say forty inches, 
his record for the right ear would then be: H.D.R.E. =|f. If it had 
been §£ or 1, the ear would be normal. £# would show an abnormally 
acute sense of hearing. If the watch could only be heard while in 
contact with his ear, it would be recorded: H.D.R.E. = g C 5 . If not 
heard at all. then ED.RE.^. Next test the left ear m the same 
way. Voice sounds in talking will often be easily heard by persons 
quite deaf to the watch tick, so that the latter is not always a reliable 
practical test. 

Suppose we have found H.D.R.E.=:|£, H.D L.E. = i, this implies 
some deafness in the right ear, and the tuning fork will now help us to 
decide whether the cause lies in some defect of the auditory nerve or 
internal ear. or in the external or middle ear or Eustachian tube. 
Strike the fork against some solid substance, and then place the end 
of the handle against or between the subject's front teeth. If both 
ears are normal he will probably seem to hear the ringing of the fork 
equally well in both ears. But if there is a defect in one ear he will 
either seem to hear it louder or more feebly in the affected ear. If, as 
in the case we are examining, the fork is heard best in the deaf ear. 
this tells us that the deafness is due to some defect in the more exter- 
nal parts of the organ, and it can probably be corrected by appropriate 
-.: ■-: '.v.: 7 v.: But if it is heard best in the g : : i ear. it g Jes tc prove :ha: 
the defect in the other ear is more deeply seated and cannot probably 
be greatly benefited by treatment. This effect of the tuning fork is 
contrary to what would ordinarily be expected, and it is often a mat- 
ter of surprise to a deaf person to find that he hears with his teeth 
apparently better on the deaf side. 

We may now add to our record in th:~ case T . F. best RE If it 
had been heard equally well in both ears we would record : T. F. =N. 
{or normalj. Where the defect in hearing is at all marked a specialist 
in ear diseases should be consulted. 



66 Special Senses. 

Our record in a normal case might be thus : H.D,RE.=i, H.D.L.E. 
= i., T.F. = N. ; or in an abnormal case it might be thus: H.D R.E. = 
i., H.D L.E. = «£j, T.F. best in R E. This would imply that the sub- 
ject was so deaf in the left ear as not to be able to hear the watch tick at 
all, and the fork held between the teeth could be heard best in the 
good ear, consequently his trouble is probably seated in the deeper 
structures of the ear, or in the nerve itself, and treatment would not 
be expected to help him greatly. The tuning fork need not be tried 
unless the watch tick shows some defect in hearing. 

When tests of the hearing are made, any dullness or 
difference in the auditory sense of the two ears should 
lead to an examination with the otoscope. The channel 
may be partially or completely occluded with wax or the 
debris from a previous inflammation or an exostosis of 
the wall of the meatus. If the opening is normal, the 
tympanum, or drum, will be seen at a depth of about two 
centimeters as a smooth, shining, semi-transparent mem- 
brane of slightly pinkish-gray color. In cases of 
inflammation the drum becomes decidedly pink. Slightly 
below and in front of the center is a white spot as though 
some white body pressed the drum slightly forward at 
that point. This is the end of the bone, the malleus, 
that conveys the vibrations back to the internal ear. In 
most cases a gray streak can be seen extending upward 
and forward, which is the body of the bone. Sometimes 
the drum will appear bulging and convex, from the pres- 
sure of serum within, and the vibrations of the drum 
are prevented, with resulting deafness. Again the drum 
may appear cupped or concave from the stoppage of the 
eustachian tube and the subsequent absorption of air in 
the middle ear, so that the drum is pushed in by the 
atmospheric pressure. This is by far the more common 
condition and only impairment of hearing results until 
the case is of long standing, when complete deafness may 
ensue. Openings in the drum are of frequent occur- 
rence as the result of inflammatory exudation bursting 



Special Senses. 67 

through from the inside, or traumatic puncture that has 
been uncared for. A puncture may not impair the hear- 
ing to any serious extent. Suppuration of the ear in any 
part should be the subject of surgical treatment at once, 
without regard to the whims or prejudices of the person 
possessing an otorrhcea. The discharge is often looked 
upon as a necessary affliction, and relief from other woes, 
but in reality it is a source of debility and impairment 
of health to the person himself, and a nuisance to others. 
Cases of impaction require treatment, and the same may 
be said of the convex drum. The concave drum may be 
due to catarrh, and if so, that should be treated. All 
these cases are to be referred to physicians. 

An organ may work correctly but slowly. The eye of 
one person sees at a glance what the eye of a second per- 
son would require seconds to reveal, and yet the eye of 
the latter may be perfect according to every test of the 
oculist. It is so with hearing. The time required 
between hearing and perceiving sounds and giving a sig- 
nal is . 12 to . 18 of a second. Higher tones require slightly 
less time than deeper ones. Noises are heard quickest. 

A distinguished teacher recently told me that he had 
called a certain boy stupid until he discovered that the 
boy was merely slow in his sense of hearing. Since that 
time he has studied boys whose perceptive faculties 
seemed dull and has found that a large percentage of 
them are deficient mainly in hearing a question that is 
put rapidly to them. A device that will test the speed of 
the action of the eye and ear correctly within moderate 
limits of accuracy will be of great practical importance in 
an educational as well as scientific aspect. Physical edu- 
cation must bring up to a higher plane of activity each 
physical function that is found to be deficient. To do 
this the examiner must be ever alert to discover unde- 
veloped functions and inventive ability will be frequently 
required to solve the problems presented. 



68 



Special Senses. 



In this connection it may be well to speak of nasal 
catarrh and its influence on health. The disease may 
be considered as a condition of mal-nutrition of the 
part affected, due to irritation of the trophic nerves. It 
may appear as an inflammation of the upper air pas- 
sages with an increased secretion of mucous fluid; or 
there may be atrophy of the mucous surfaces and of the 
harder tissues beneath ; or there may be extensive ulcera- 
tion, and decomposition of secretions. 

The first form is due to the action of irritants on a 
supersensitive membrane. The condition can be pro- 
duced almost instantaneously by the inhalation into the 
nasal openings of snuff from pulverized tobacco, acrid 
fumes, dust, etc., but the hyperaemia is temporary if the 
irritation is not repeated. Sudden changes from a warm 
to a cold atmosphere do not give the system time for the 
nice adjustment to environment that enables man to live 
in every climate where food can be found. The result is 
a continued irritation of the mucous surfaces of the air 
passages and a resulting inflammation with thickening of 
the superficial tissues until the normal nutrition of the 
part is lost, and disease becomes seated. This swelling 
may close the openings of the eustachian tubes, and im- 
paired hearing is the result. Treatment is usually suc- 
cessful, and hence the importance of examining the nasal 
chambers if the history discloses any suspicion of defect 
in this locality. The other forms of catarrh are often 
quite as distressing without as favorable a prognosis, 
but relief will not be sought in vain. 

The sense of smell in the atrophic and erosive forms 
of catarrh is often entirely lost, and in all cases is de- 
ranged. This sense may be tested by inhaling odors 
that are bland and unconnected with articles of food, as 
musk, attar of roses, etc.* 



* Scripture — Thinking, Feeling, Doing, p. 124. 



Special Senses. 69 

The olfactory nerve is perhaps more intimately con- 
nected with the brain tissue than any other, being appa- 
rently a prolongation of the brain through the cribriform 
plate to the nasal walls. As many cases of headache are 
due to a bad condition of the surfaces where this nerve is 
spread out we should examine such cases for ulcerations, 
tumors, malformations and displacements that may 
cause occlusion or pressure. 

The sense of taste is closely allied with that of smell, 
but is not so important an indication of the condition of 
the organs with which it is connected. It is a sense 
with great capacity for education, as it was the boast of 
Roman epicures that they could tell by the taste of a fish 
whether it was caught above the Bridge or below. A 
taste may be acquired for the most nauseating sub- 
stances. Children have been known to cry for cod-liver 
oil. But while the sense of taste is not important in its 
relation to health, the condition of the mouth may well 
occupy our attention in discovering those facts in a man's 
condition that make for health or debility. A clean 
tongue indicates good digestion ; while a coating indi- 
cates some abnormal condition of the stomach, or liver, 
or pharynx. A cracked tongue means dyspepsia. The 
tonsils should not protrude beyond the pillars of the 
fauces; the general surface of the pharynx should be 
smooth and of light pink color; the teeth should be 
sound or rilled ; the vocal cords should be a light, pink- 
ish yellow, and the tracheal rings below look like white 
bands, between which pink tissue can be faintly dis- 
cerned. 

The temperature should be taken with the bulb of the 
thermometer placed under the subject's tongue for five 
minutes. This should be a record of 98. 4 F. without a 
variation of half a degree. If the temperature is below 
normal note carefully the general conditions and repeat 



70 Special Senses. 

the test at some future time. About one or two per cent 
of cases have a subnormal temperature. The instrument 
should be carefully washed in an antiseptic fluid after 
using and it is well to have a cup of saturated solution of 
boracic acid into which the mouth-piece of spirometers, 
etc. , can be placed after taking records with them. 

The tests of urine for albumen and sugar should be 
practiced until the examiner is sure of his ability. The 
chemicals now prepared by leading manufacturing chem- 
ists and druggists leave little except skillful manipulation 
to the examiner. The record should be repeated if any 
abnormality is found and the subject placed under the 
advice of a pl^sician. 

The director of a gymnasium should always recom- 
mend some other physician to cases needing medical care. 



CHAPTER V 



TESTS OF STRENGTH. 



The importance of strength tests as a department of 
anthropometry demands that special attention be given to 
it at present. The earlier tests that were applied in 
anthropometrical investigations related to the size or 
mass of the various parts of the body, and it was sup- 
posed that high record, coupled with a good proportion, 
constituted a highly desirable condition and that exercise 
might be prescribed on this basis. Practical experience, 
however, soon demonstrated the absolute need of other 
data than those relating to bulk and proportion if exercise 
were to be prescribed appropriate to the capacity of the 
individual. The large man is not always the strong 
man, and with equal truth it may be said that the strong 
man is not always the man of high endurance. The work- 
ing muscle is a machine that depends upon two factors for 
its efficiency. First, it must have size, or an adequate 
aggregation of cells, each one of which is involved in the 
activity of the whole, as the total strength of the muscle 
is made up of the sum of the strengths of the individual 
cells composing it. Second, it must have adequate inner- 
vation in order to set up the metabolism that sets free the 
stored energy. If continued exertion is to be considered, 
a third important factor appears, namely, sufficient circu- 
latory activity to bring fuel to the cells and to sweep 
away combustion products The variety in the girths 
of different individuals, especially in the first half of life, 
may be attributed in some degree to the difference in the 
size of the muscles, but the modifications may be largely 
due to the presence of storage tissue that has no imme- 



72 Tests of Strength. 

diate relation to the muscular ability. The girth of the 
head, on the other hand, bears no direct relation that has 
yet been determined to the nerve force that may be 
applied as a stimulus to muscular contraction. We must, 
therefore, in estimating the muscular ability of a person, 
have other data than the record of size. Since muscular 
activity is externally manifested in forms of strength act- 
ing against resistance it would seem plausible that a 
series of strength tests that should at least include the 
principle groups of muscles would be a safer guide in 
determining the amount of work that may be advanta- 
geously done, than any other data that can be secured. 
To secure such tests of strength has taxed the ingenuity 
of physical directors in times past and with some the 
extensor power of the legs in lifting has been considered 
a fair test of the person's muscular power and prepara- 
tion for work. Others, more devoted to that form of 
exercise ordinarily classified as heavy gymnastics, have 
considered the strength of the extensors of the arm as a 
similar indication. Medical men have relied particularly 
on a test of the contractile power of the flexor muscles 
of the hand. With the advance of anthropometric science 
the inadequacy of local strength tests has been demon- 
strated, and gradually methods of testing with fair accu- 
racy all the general groups of muscles have been estab- 
lished. The earliest forms of dynamometers that have 
been found fairly efficient in securing local tests are 
shown in the accompanying cuts (Figs. 11-12-15). The 
general type of these instruments has been that of the 
elliptic spring. The variation of its contour being 
accomplished by pressure or by tension, and recorded by 
an index that is moved forward by the moving side of the 
spring. These instruments have been of French design 
and have been applicable only to a very limited range of 
use. About ten years ago Dr. J. H. Kellogg, the medi- 



Tests of Strength. 



73 




Fig. 32. 



cal superintend- 
ent of an exten- 
sive sanitarium 
at Battle Creek, 
Mich., began to 
apply strength 
tests as a prelim- 
inary to the ex- 
ercise which was 
prescribed exten- 
sively as a therapeutic means in 
his institution. The small number 
of muscular groups that could be 
measured in this way led him to 
study the possibilities of a mechan- 
ical device that should be capable 
by proper adjustment to record the 
acting power of all the skeletal 
groups with a fair degree of pre- 
cision. The first result of his inves- 
tigation was the instrument 
described in a previous edi- 
tion of this book. The 
friendly criticism of those 
who were interested in his 
investigation and his own 
mechanical genius soon 
enabled him to produce 
another instrument, based 
1 on the same general prin- 
ciple, and relieved of the 
theoretical and mechanical 
imperfection of the first. 
An extensive use of the 
first instrument had demon- 
strated the . faults that 



74 Tests of Strength. 

should specially be guarded against in the later product. 
His instrument as now completed is shown in Fig. 32, and 
consists essentially of a frame made of two upright rods, 
which serve as a support to the testing mechanism. This 
mechanism balanced by a counter-weight can be readily 
moved up or down to any position, and there fixed by four 
set screws to the frame. The mechanism consists of a 
lever arm terminating in a handle, which is always the 
point of application of the force. This lever can be moved 
upon its fulcrum through ninety degrees so as to receive 
force applied in a horizontal or in a perpendicular direc- 
tion. A coupling pin transfers this force to a perpendic- 
ular lever arm which acts against the resistance. This 
resistance is secured by the following mechanism : A 
glass tube of 1 mm. calibre and one meter in length runs 
to the bottom of an iron cistern where it is tightly held 
by a screw acting upon a rubber washer. The bottom 
of the cistern contains two ounces of mercury. A layer 
of water is superimposed upon the mercury and the cis- 
tern is then completely filled with light machine oil or 
alboline. Connected with this cistern is a horizontal 
cylinder into which a piston of about 60 mm. diameter fits 
with mechanical exactness, and the end of this piston is 
acted upon by the lever arm of resistance described 
above. The other end acts upon oil which fills the cyl- 
inder to the extent of about one-third of its capacity. 
When force is applied to the handle, pressure is exerted 
upon the end of the piston, which in turn acts upon the 
oil, driving it through into the cistern containing the 
mercury and water, and as the only opening into this 
cistern is by the glass tube, the mercury is driven up 
into this tube, until the pressure of the compressed air in 
the tube, plus the weight of the mercury column, bal- 
ances the pressure exerted upon the handle of power. 
The graduation of the instrument is accomplished by 



Tests of Strength. 75 

having the rods that support the glass tube carry a scale 
that is marked empirically into spaces. It will be seen at 
a glance that the mechanical conditions are perfect and 
constant for a constant temperature. The capacity of 
this instrument is sufficient to record a pressure as light 
as one-fourth of a kilogram and it has been repeatedly 
subjected to a strain of 800 kg. without injury. In con- 
nection with Dr. W. A. George, t Dr. Kellogg has prepared 
percentile charts from the records of the strength tests 
of six hundred men and six hundred women that may 
serve us as a basis for the graphic representation of the 
strength of any person. Reduced copies of these charts 
are shown in Figs. 33-34. It should be stated that these 
charts are not prepared strictly according to the percen- 
tile method, but are a combination of the average and 
percentile methods as described on page 188 of Dr. Kel- 
logg's ' 'The Art of Massage." It need only be added 
that this method gives great authority to the fifty per 
cent line, as representing an essential average of a 
group from which monstrosities have been eliminated. 

I can testify from personal observation to the facility 
and accuracy with which exercises may be indicated for 
a person when his strength record is graphically pres- 
ented on one of these charts. The general theory and 
method of the prescription cannot be better described 
than in Dr. Kellogg's own words which are taken from 
the book above mentioned : 

" The data afforded furnish exact information concern- 
ing the capacity of each of the principal muscles in the 
body. Knowing the capacity of each muscle, it is easy to 
proportion the work in such a manner as to secure sym- 
metry of development. My plan for accomplishing this 
is as follows: 

" Take 300,000 foot pounds, one-sixth of a full day's 
work, as the proper daily amount of exercise for a man 



7 8 Tests of Strength. 

whose total strength capacity is 10,000 pounds, correspon- 
ding very nearly to the greatest capacity shown upon my 
table, prepared from two hundred young men in vigorous, 
health. I have undertaken to establish a definite relation 
between the strength capacity and the total amount of 
work to be performed. This is accomplished by simply- 
dividing the total amount of work done by the total 
capacity of the muscles; that is, 1,800,000 is divided by 
10,000, giving 180. In other words, for each pound of 
capacity the muscles are capable of doing 180 foot pounds 
of work daily, an interesting physiological fact thus for 
the first time determined. One-sixth of 180 is 30. 
Hence it is clear that in a symmetrically developed man, 
with a total strength capacity of 10,000 pounds, each mus- 
cle, in order to do its proportion of the 300,000 foot pounds 
prescribed, must do work to the amount of 30 times its. 
lifting capacity represented in foot pounds. 

"It is only necessary, then, in order to ascertain the 
exact amount of work to be done by each group of mus- 
cles at each level, to multiply by thirty the figures of 
each column of the chart. 

" I have made a careful approximate calculation of the 
amount of work done in each exercise or set of exercises, 
with each apparatus in the gymnasium under my super- 
vision. It is necessary to know the strength of the medi- 
cine, as well as the needs of the patient. Knowing the 
amount of work required for each individual and for each 
set of muscles, and also the result obtained from each 
exercise, it is easy to construct tables of exercises exactly 
adapted to any capacity. I have arranged ten series of 
such tables, or day's orders, five for each of the two charts. 

11 In making a prescription for exercises, I first note the 
total capacity of the individual, and then write down a. 
number indicating the day's order which would secure 
for an individual of the given capacity the proper 



Tests of Strength. 79 



amount of work. Then glancing over the chart I note 
the low point, and check or underscore each of these, 
which indicates to the assistant who superintends the 
exercise in the gymnasium, that the work is to be doubled 
on all such points, so as to secure to the weak muscles 
such rapid development and growth as will enable them 
to overtake the rest of the muscles and thus restore mus- 
cular symmetry. In practice, I find that this method 
never results in giving to a muscle more than a full day's 
work and consequently there is no danger of injury result- 
ing from this doubling of the amount of work to be done 
by the weak muscles. In case of complete paralysis of 
the muscle, it is of course necessary, at the beginning, to 
administer the exercise by electrical or mechanical 
means. 

"As a rule I find it sufficient for practical purposes to 
divide the series of total capacities represented upon my 
table into five groups, instead of making a distinct sched- 
ule of work at each of the levels indicated by the several 
quantities representing total muscular capacity. 

" The ratio which I have established between the mus- 
cular capacity and the day's work is probably too small 
for those in vigorous health ; but I find it well suited for 
the class of persons coming under my observation who 
are, for the most part, invalids or semi-invalids. The 
man who is training and desired to develop his whole 
body to its highest capacity, should be required to exe- 
cute a full day's work — 1,800,000 foot pounds or even 
more. In arranging a day's order of exercise, due 
account is of course taken of the work done in walking, 
running and similar exercises, which may be made part 
of the program. 

" The patient does not undertake the first day to do all 
the exercises prescribed in the series, but gradually takes 
them up from day to day, as he learns them, and becomes 



8o Tests of Stre?igth. 

able to do them, and by the end of two or three weeks 
he is expected to have thoroughly mastered all the exer- 
cises given him, and to have become able > to take each 
time all that is directed in his prescription. At the end 
of another month another chart is made, the changes 
noted and a new prescription prepared according to the 
requirements. It is a matter of frequent observation 
that the points which at the first examination are lowest 
on the chart, are so improved by the specific exercise 
directed to these particularly weak muscles that they 
become the highest one upon the second chart." 

A study of proportional strength tests and the 
increase during one year among women in their twenti- 
eth year, representing the records of one hundred 
Smith College students, is presented in the following 
table prepared by Miss Berenson : 



c 

o 

V 

On 


co 




be 
V 


be 


on 
O 


Ofl 
V 

JZ 

U 


5 




J- 


Cu 
O 




u 


a 

U 

be 


a 
a 
U 


5 


33-5 


62 


46.5 


74.I 


14.3 


20.5 


13-5 


18 


II 


16 


1.8 


2.1 


IO 


36 3 


70.2 


50 


78.9 


16 


23 


16.2 


19-5 


12.6 


17 4 


1.9 


2.2 


20 


42.5 


72.3 


56.5 


87.1 


18.8 


25-3 


17. 1 


22 


15 


19-3 


2.08 


2.3 


30 


48.9 


74-5 


62.8 


94.9 


20 2 


26.5 


18.8 


23.8 


16.5 


20 4 


2.2 


2.48 


40 


54 


77 


68 


IOI.5 


21. I 


27.7 


20 


24.7 


17-5 


21 


2-3 


2-57 


50 


58 5 


80 


72.1 


106 


22 


28.8 


21. 1 


25 


18.5 


21 9 


2-39 


2.66 


40 


61.5 


85 


77 


III 


23.3 


3'o 


22.5 


25 5 


19.4 


23 


2.4 


2.7 


30 


6 j. 2 


89-5 


83 


117 


24.9 


31 2 


23.7 


27-5 


20.5 


24-3 


2.5 


2.8 


20 


68.8 


94 


88.9 


123.9 


27 


32.9 


25 4 


29.1 


21.5 


26 


2.6 


2.9 


10 


81 


100.5 


94-9 


136 


29-5 


35-5 


28 


32. 1 


23.5 


29 


2.7 


3-i 


5 


87.6 


103.5 


100.5 


162 


3i-5 


37 


29-5 


35-5 


25.6 


31.5 


2.8 


3-29 



The numbers 1 and 2 placed after the items indicate 
the first and second measurements respectively, the 
second being taken after an interval of nine months. 
The figures represent kilograms and liters. It is 
interesting to note that the absolute increase for 



•^pog ! .._ 


•^anaj, y ^oqo " P- "fr-^T~ > ' . 


•^eaqo ~^5- ';►. 


•jjutux .-''*"***■'' 


•sgai; qjog <^** <;"]' 


•38T 1J3T ***>.. '--.. 


•Sai iqSia ^ j J 


•sum yq jog '4-f... i 


•raavu»l *) V t 


•may ^qSiy; ' i 


•spanoj iSill§lliiSil§l§l 8 llliillilliii§liliiilliilllillilillllilsS2S 




(•uj) uidxg; j 


(•u^) -aidsui -J 


•(isaqo) \ndsui ,- 1"" r" 


•(jsrBAV) 'iidaui V s ^ 


'lBJ91'B r I '2109*1 N s 


UOUajSOJ *5l09Js[ ^s^ \ 


uouajnv '^psR _ . ^ ». - * 


•IBia^i; ^utijj, «,«••"" /'""" 


•jouajsoj 'jjamjj *--!' -~. 


•aotJ8;uv '^utuj, X. ~;> 


•Biojonppv qSmi {""''" ,'"' 


•saojonpqv qStqjj j> ) 


•suosag^xg; qSiq j, ---"" " ,'' 


•sjoxai^ qSiqj, \ v '-.. 


•8J03U9+xg; Sd'j >s v N "\ 


•8JOX9U Sd'J S v \ 


•9JOX9IJ JOO^ ^S. - 






•S[BJ0P9<I <^" 


•P!0U3Q """*> > 


•ISIOQ STIUIISSIJBT <' 


•ejosugjxg; may ,s,s, i "^ 


•sjoxaj^ may 1 > 


•+buojj mj^gjo^ J 1 


•l.T3mdng niaBgjo^ i | , 


•sjosugjxg; pa«n * * ; ; *^ J 


•sjox9i^[ paRH ""I -■--■' 


•epaticvr ||lS||||||2|||S||||I2|||||g|||2|||g||S||2|§sg|g5iS2|ggeSSSSSS 






82 Tests of Strength. 

the students strong at the beginning - of the year is 
essentially the same as for the weaker students, and for 
those of medium grade, although the proportional 
increase for the weaker students is greater. It would be 
a great help to the more complete study of methods of 
physical education, if such records as this from Smith 
College could be secured for the whole group of students, 
and for every year during the college course. Some- 
what similar reports have been issued from Wellesley and 
Oberlin Colleges, but here the whole group is included 
(see pages 102 and 103). 

Foster states that the strength of men and women bear 
the relation of 9 to 5. A more complete comparison is 
made by Dr. Kellogg in the graphic plate (Fig. 35) which 
shows the average strength values for the various mus- 
cular groups of both men and women. 



CHAPTER VI. 



SPECIAL INSTRUMENTS. 



The number of instruments that 
have been invented to demonstrate 
anatomical and physiological facts 
within the past ten years bears wit- 
ness to the extent and earnestness of 
the study of the human body. Only 
the principal ones can be 
described here and that 
briefly. 

An instrument for 
measuring the obliquity 
of the pelvis has been in- 
vented by Dr. Mosher 
which is of especial value 
to those examiners who 
are working with women. 
It has been demonstrated 
by gynecologists that the 
position of the brim of 
the pelvis as regards per- 
pendicularity has a very 
important bearing on the 
E. health of the pelvic or- 
gans. The mechanical 
reason for this is appar- 
ent to all. To measure 
Fig. 36. and determine what may 

b>e considered the normal position and what limits may 
t>e considered safe variations from this normal is the 




8 4 



Special Instruments. 



Fig. 37- 



province of those who have charge of the hygiene and 
physical training of women. The obliquimeter enables 
the examiner to determine the angle of pelvic tip with 
accuracy and at small cost of time and effort. The 

instrument as 
shown in Fig. 36 
consists essential- 
ly of a fixed arm 
that can be ad- 
justed to theheight 
of the individual. 
A second arm, A. y 
movable upon a 
pivot, carries a 
pointer that 
sweeps over a 
graduated semi- 
circle. The person 
to be tested stands 
in an ordinary 
posture, the fixed 
arm of the instru- 
ment is placed at 
the junction of the 
sacrum and the 
last dorsal verte- 
bra. The movable 
arm is then swung 
down until it rests 




upon the pubic symphysis. The reading is then made 
in degrees as indicated by the pointer. A similar instru- 
ment has been invented by Dr. J. H. Kellogg (Fig. 37). 
It is based on similar mechanical principles, but is some- 
what simpler in its mechanism. Probably the amount 
of pelvic tip is of less importance in men, although its 



Special Instruments. 85 

relation to congestive conditions, hemorrhoids, etc., may 
yet be demonstrated. 

The measurement and abnormalities of the spinal con- 
tour has been for many years a somewhat perplexing 
study, and the various devices that have been originated 
have nearly all been laid aside as too inaccurate in their 
results or too complicated in their management to be of 
high utility. An instrument was devised by G. Demeny, 
of Paris, which he called a thoracometer, for showing 
the exact contour of the chest at any level. This 
instrument, is made in two segments that can be 
clasped firmly together around the trunk. Running 
through the band and supported by it are many little 
rods that are pressed forward, each by a spring, and that 
are held in any position by a single clamp that acts on all 
at the same time. The instrument is mounted on a stand 
so that it can be raised or lowered to be accommodated 
to any height. The rods are all pushed backward and 
clamped. The instrument is then placed upon the chest 
the clamp is released and the springs carry the rods for- 
ward until the tips rest against the surface of the thorax. 
The clamp is now applied and the instrument removed, 
laid over a sheet of paper and the position of the points 
of the rods marked with a pencil. These dots are then 
connected, and the exact contour of the chest is shown. 

A second instrument was subsequently devised by the 
same person for tracing the antero-posterior depths at all 
points of the trunk. This instrument consists essentially 
of two small wheels that pass one along the spinous pro- 
cesses while the other passes down the median line in 
front. These wheels are mounted upon a frame work 
that carries pencils that mark the outline traversed by the 
wheels. Obviously this instrument can be used for 
demonstrating changes in outline during respiration. 
The thoracometer described above is made on the same 



86 



Special Instruments. 



mechanical principle as a more elaborate machine, inven- 
ted by Zander of Stockholm, for making an outline of 
the body at any level. It is, however, much simpler and 
equally efficient. 

Instruments for recording outlines of the body have 
been devised by Drs. J. H. Kellogg,* C. L. Scudder,f and 
the author. The former secured a full size outline of 
the body by placing the person in a framework for sup- 
port while on this framework slides, carrying pencils on 
arms movable in one direction, were made to travel up 

hi 



\L 




\ i 



and down keeping one extremity in contact with the 
body. Some very satisfactory results have been obtained 
by the use of this instrument, as shown by the series of 
outline drawings of the human form issued by Dr. Kel- 
logg. The device of the author was prepared in 1892 and 
was exhibited at the meeting of the American Association 
for the Advancement of Physical Education in Philadel- 
phia, in April of the same year, as a means of giving a 

* See Transactions of Amer. Ass'n of Obs. and Gyn., 1890. 
f Bost. Med. and Sur. Jour., 1891. 



Special Instruments. 



reduced and exact outline of 
spinal curves both lateral and 
antero-posterior. 

The instrument is based upon 
the principle of the pantograph. 
The form is that of a double 
trapezium (Fig. 38). One ex- 
tremity carrying a marker 
and the other a pointer for 
following the surface to be 
outlined. The proportional re- 
lations are such that the instru- 
ment produces a drawing one- 
third the size of the object that 
is outlined. This being a con- 
venient size for reference and 
preservation. The pantograph 
is hung upon a swinging tablet 
that is placed at such a height 
as to make it available for re- 
ceiving the outline of any part 
of the body. The person to be 
outlined is placed in a frame 
and movable supports are 
brought against him, at shoul- 
ders and hips so that he may 
not move while the outline 
is being made, 
which requires 
only a few sec- 
onds. The in- 
strument will be ~Z 
found useful in 
making records 
)f the special 




Fig. 39. 



88 Special Instruments. 

•cases of deformity ttiat may be under observation. 
Improvements on the instruments there shown have 
"been made by W. S. Jackson and the author. The 
instrument may now be said to have some utility in 
securing outlines of the trunk and of the spinal column. 

A method of recording abnormalities of spinal curva- 
ture has been invented by Thomas Elkinton of Philadel- 
phia, Fig. 39. It consists of a frame the length of the 
spinal column. This frame carries a series of rods that 
are freely movable back and forth. The frame is sup- 
ported by an adjustable stand so that it may be adapted 
to the height of any individual. The person stands in 
customary attitude and is supported there by a fork- 
shaped support that is applied to the shoulders. The 
rods are then pushed forward until their ends strike 
against the spinous processes throughout the entire spinal 
column. The other ends of the rods play over a sheet of 
paper and their position is marked by a pencil, thus giv- 
ing a series of dots that may be connected and an outline 
of the antero-posterior curves secured. If at any partic- 
ular level there be any lateral deviation this may be 
measured horizontally and indicated by a figure on the 
chart at the level where the deviation occurs, and these 
may then be laid off to the right and left of a perpendic- 
ular line and the displacement shown graphically. An 
instrument somewhat similar has been made by the 
author to demonstrate chest movements during respira- 
tion, three rods only being used, and these being 
pushed forward by a spring so that they follow the move- 
ment of the wall to which they are applied. The other 
end of each rod carries a marker that indicates the excur- 
sion of the rod. 

In connection with instruments for recording abnormal 
deviations of the spinal column it will be well to call 
attention to such instruments as have been designed to 



Special Instruments. 89 



cause of the curvature. It has been noted by examiners 
that in about three-fourths of the cases of curvature of 
the spine there is a decided difference in the elevation of 
the iliac crests. This difference may be readily noticed 
by observation of the difference in waist curve on the two 
sides, the greater projection of one hip, and the differ- 
ence in level of the superior spinous processes, both 
anterior and posterior. 

It may be stated in this connection that apparent 
departures of the pelvis from the normal level do not 
always indicate a difference in the lengths of the two 
legs, as it may be caused by pelvic distocia or even by 
prolonged abnormal posture. However, so far as scoliotic 
curves are concerned they may properly be attributed to 
the uneven base of support that is furnished by the later- 
ally tilted pelvis when there is a difference in the height 
in the two sides of the pelvis. It becomes then the duty 
of the examiner to recognize any failure in- lateral sym- 
metry of bone lengths and to record as far as possible his 
observations, for if the scoliosis be occasioned mechan- 
ically a mechanical remedy will prove efficient and will 
be, in most cases, the only one indicated. To measure 
the exact length of the two lower extremities is not an 
•easy matter, and different methods have been suggested 
to accomplish this end; that employed by surgeons has 
been to measure with a tape line from the anterior supe- 
rior spinous process of the ilium to the internal malleolus. 

Also to measure to the external malleolus and from 
the umbilicus to the internal malleolus on either side. It 
is essential in taking these measurements that the exam- 
iner do not retain a position on the tape in passing from 
one side to the other, and also that he do not look at the 
reading on the tape until the exact position is determined 
and the tape removed. To discover the spinous pro- 



90 Special Instruments. 

cess the finger should be pressed well down to the lower 
edge of the prominence where a well defined point or 
hook-like projection will be found. In no other way can 
a true landmark be found. 

A test of the accuracy of the ordinary surgical method 
of measuring the length of leg from the spinous process to 
the malleolus has been made by Prof. Thomas Dwight, 
M.D., of the Harvard Medical School.* The measure- 
ments were made on the cadaver and after dissection the 
actual length of the bones was determined. He found 
that the error was less than 3 mm. in 41 per cent, of the 
cases, and that an error as large 1 cm. was made in only 
7 per cent of the cases. The probable error is, there- 
fore, very small when the examiner is careful and expert 
in locating the exact points of measurement. 





M 


S 






V 


' m 


^ 


v£iL~__ " 


/""U 




J 



Fig. 40. 

A landmark to which attention has been called by anat- 
omists is the comparative height of the gluteal folds on 
the two sides. The value of this record is suggestive 
rather than accurate, for it is found that there is not abso- 
lute uniformity of the folds in persons where no pelvic tip 
can be demonstrated, but it may be stated that in all 
cases where there is an inequality in the length of legs 
there will be an unevenness in the heights of the folds. 
A simple instrument for measuring this unevenness has 
been devised by Thomas Elkinton. It consists of a 
ruler with a level attached to it and having a 
a parallel ruler of half the length attached to it, as seen 

* Boston "Med. and Sur. Jour.," Vol. CXXXIL, No. 18. 



' 



Special Instruments. gi 

in Fig. 40. The ruler is held horizontally so that the 
upper surface touches the lower gluteal fold. The par- 
allel portion is then moved upward until it touches the 
higher fold, and the difference in the heights of the two 
portions may be readily measured and recorded. The 
same person has also suggested a simple means of meas- 
uring the comparative length of the legs by having the 
subject lie carefully upon a line so that it shall pass 
between heels and along the spinous processes to the 
middle of the occipvrt. Two light box-like supports are 
then placed under the legs and are pressed firmly against 
the sole of each foot with equal pressure on either side. 
A difference in the length of the extremities will be indi- 
cated by a projection of the support on the longer side, 
and can readily be measured by a ruler. The method 
is simple but will not record accurately the total differ- 
ence in length, probably because of the partial fixation of 
the pelvis in a somewhat tilted position by the long con- 
tinued posture that has been necessitated. 

The author has found that a difference in the height 
of the pelvic crests may usually be determined by having 
an assistant press two narrow rulers inward and down- 
ward upon the sides of the person just above the iliac 
bones and then measure to the under surfaces of the rulers. 

It is not claimed that this gives a true indication of the 
absolute amount of elevation that will be required under 
the low side to render the support of the spinal column 
horizontal. A second method that is suggested is a. 
ruler carrying a level that is affixed to the caliper section 
of the measuring pole used by the author as shown in 
Fig. 41. The caliper is applied by pressing its arms- 
firmly upon the tops of the iliac crests while the person 
stands in normal position bearing the weight equally on 
each leg. The free end of the ruler is now elevated 
until it is horizontal. The pelvic tip can then be read in 



92 



Special Instruments. 



terms of an angle, or in terms of linear units by measur- 
ing the divergence of the end of the ruler, which is made 
the length of the average pelvic breadth. Probably all 
that can be claimed for this latter method as an advan- 
tage over other methods is the ease with which the record 
is taken, both for the examiner and the subject. 

Dr. Wilson has made a plat- 
form easily adjustable in height 
by a screw and is accustomed 
to place the subject with the 
foot of the low side resting on 
this platform. He then raises 
the platform until the pelvis 
is horizontal. The elevation 
of the platform gives an indi- 
cation of the amount of artificial 
elevation that should be applied 
to overcome the scoliosis. 

An instrument for recording 
the bilateral movement of the 
chest in ordinary or forced res- 
piration has been invented by 
Richard Hogner, M.D.* The 
instrument is applied somewhat 
like an ordinary tape at the 
level at which the movements of 
Fig 41. the chest are to be recorded. 

The only advantage of the instrument, over the thora- 
cometer of Demeny, lies in its adjustability to a higher 
region of the thorax, but the circuitous route that the 
tapes traverse in reaching the upper thorax invalidates 
the records made so that the instrument has not come 
into general use. 




*N. Y. "Med. Rec," Vol. XL., N< 



CHAPTER VII. 



GRAPHIC ANTHROPOMETRY 



Within the last ten years various devices for applying- 
the principles of graphic mathematics to the measures-- 
and tests of men have been invented. These have been 
the outgrowth of the graphic method of Quetelet for 
showing the mean of any part, as chest girth or height,., 
and the tables of averages and means published from 
time to time during the last twenty-five years by Dr. 
Hitchcock of Amherst, and the tables of percentages pub- 
lished by Francis Galton and other students of anthropol- 
ogy- 

The oldest record of anthropometrical data in any col- - 
lege in the country is to be found at Amherst, where from •. 
1 86 1-2 to this date the students have had the advantage 
of a physical examination, and advice regarding exercise^,, 
and a record of their general size has been secured. 

In 1867 W. T. Brigham of Boston made a study of 
the proportions of Mongolian emigrants.* In 1869 he^ 
began to take the measurements of American young 
men and for this purpose used a list of measurements 
and records that was later adopted in essential form as- 
the list of the American Association. He measured 
several hundred Harvard students and other men, but. 
never published his data. 

The items given in Dr. Hitchcock's list are extended in 
the record book of Yale b)^ the addition of age, breadth 
of chest, development, condition, exercise, vision, hear- 
ing, color of hair and eyes, pulse rate, and use of 
tobacco. The horizontal length is omitted. It may be; 

*Proc. Bost. Nat Hist. Soc'v., 1867. 



94 Graphic Anthropometry. 

said that at Amherst the record of each student is tran- 
scribed for him on a table that is compiled from the 
measurements of men of the same height. The table 
here shown on the opposite page gives the averages 
obtained from five colleges, the material having been 
obtained by one man in each institution. 

In 1880 Dr. D. A. Sargent of Harvard began a system- 
atic record of measurements of students examined by 
himself. He has endeavored to determine a physical 
standard for American college students that should be 
derived from a tabulation of all the measurements that 
could be secured. The work was very comprehensive 
in scope and the main results have not yet been given 
to the public, but a partial result has been seen in the 
graphic chart that was prepared in 1886 (Fig. 42) by which 
he was able to give a person an idea of how he compared 
with the whole body of students whose measures had 
been tabulated. A second result was seen in the July 
and November numbers of "Scribner's Magazine" for 
1887, where, in an article on "The Physical Character- 
istics of the Athlete," certain well-known men were 
pictured graphically as well as literally, and thus the 
application of the method was more clearly impressed 
on the minds of persons engaged in physical education. 

Meanwhile Dr. Hitchcock of Amherst College, who 
had published tables of average measurements of 
Amherst students of all ages, from fifteen up to twenty- 
eight years, and tables of averages where height 
instead of age was the basis of tabulation, issued a table 
in which the latter averages were arranged on a sheet in 
order from shortest to tallest, by gradation, of one cen- 
timeter, and the records of an ordinary person could 
be indicated on this new table in a graphic way. In 
1887 an "adjusted averages" table was prepared as a 
simple acknowledgment that the tables were compiled 



AVERAGES OF COLLEGE STUDENTS. 








Amherst. 


Cornell. Wisconsin 


Yale. 


W.&J. 


AGE, 


20.8 





20.1 


20.3 





WEIGHT, 


6l.2 


6l.2 


63-3 


63, 


63 .1 


HEIGHT, 


1725 


1725 


1726 


1724 


1730 


" Sternum, 


I4IO 


1406 


1415 


1416 





" Navel, 


IO3O 


IO30 


1030 


1033 





Pubis, 


860 


859 


864 


860 





Sitting, 


903 


904 


903 


903 


895 


" Knee, 


478 


424 


45i 


448 





LENGTH, Should., Elb. 


369 


373 


37o 


372 





Elb. to Tip, 


460 


461 


462 


461 





" Arm Reach, 


1780 


1782 


1792 


1790 





R. Foot, 


260 


258 


260 


258 





L. Foot, 


259 


258 


260 


258 





GIRTH, Head, 


572 


570 


575 


570 





* 4 Neck, 


353 


349 


357 


350 


346 


Chest, dep. 
inf. 








839 


846 


846 


926 


929 


934 


924 


910 


" " nor. 


880 


884 


878 


875 





at 9th Rib full, 











887 





a << .« (Jgp^ 











824 





Waist, 


723 


726 


73i 


725 


719 


Hips, 


893 


895 


904 


888 


888 


" R. Biceps, 


295 


298 


300 


293 


293 


44 L. Biceps, 








292 


283 


285 


R. Arm, 


260 


258 


259 


256 


256 


L. Arm, 


258 


251 


256 


248 


250 


R. Elbow, 


251 


251 


231 


229 





" L. Elbow, 


247 


246 


229 


224 





" R. Forearm, 


267 


258 


265 


264 


265 


L. Forearm, 


261 


258 


259 


258 


258 


R. Wrist, 


166 


165 


169 


165 


165 


L. Wrist, 


164 


164 


167 


164 





R. Thigh, 


520 


513 


524 


515 


507 


L. Thigh, 


517 


5ii 


522 


513 


501 


R. Knee, 


361 


359 


362 


357 





" L. Knee, 


359 


357 


359 


359 





R. Calf, 


349 


354 


352 


35o 


339 


L. Calf, 


349 


348 


350 


350 


339 


R. Instep, 


241 


242 


240 


233 





" L. Instep, 


239 


240 


239 


234 





BREADTH, Head, 


155 


154 


156 


155 





" Neck, 


108 


107 


107 


107 





" Shoulders, 


430 


434 


435 


410 


415 


Chest, 








279 


273 


270 


Waist, 


254 


252 


251 


253 





" Hips, 


323 


323 


325 


323 


319 


DEPTH, Chest, 





. 


187 


186 


184 


Abdomen, 








181 


182 





CAPACITY, Lungs, 


3.78 


4 24 


4.05 


4.00 


4-05 


STRENGTH of Back, 


138 








150 





Legs, 


164 








181 





R. Forearm, 


40 





56.8 


54 


57-3 


L. Forearm, 


37 





54-5 


47 


50.4 


Pull Up, 


9-5 














Push Up. 


6. 














DEVELOPMENT, 


HEARING, 








CONDITION, 


COLOR of Hair, 






EXERCISE, 


" 


" Eyes, 






VISION, R. Eye, 


PULSE, 








44 L. Eye, 


TOBACCO, 









JE ABC 

I 95 00 80 70 60 £ 


>0 40 30 20 10 5 \ 


I 5 10 20 30 40 £ 


ow ; 
60 70 80 CO 05 s 






*e« „ 




<C5 _ 

Weight... S ^ 




Height Standing. \ 




7 --.* — t 

" Sitting.... ,/ ^ - 




•• Knee , 




" Pubk Arch "" "" - - a ^ ^ ^ * ' 




" Sternum.. ■g"^'^^" 




Girth Head ~" i5 -4i t , 


T| 


"■ Neck _»e- — ""' $ - 


+:::i; 


" Chest __ _^' 


t 


•• Full.. -r _ _ _ _ _ 




■' Waist V ^ %> »*i 


II IT P" M 


" H,p» .^cC^tl'. ' 1 


I t~l 


" Thigh R... __ s s,P^ 


_T L t 


'•' " L.. _ _ I 


Trrr rf 


•• Knee R.. _ __ ~~~ ~~-~ ;r ^-, 


L f I 






" CalfR _ _ _---:^- :: "'" 


^ r + i 


L.„. 2 — -1 — .: 








p - - ---- --■"s-r 

•• u. __ . _,vj; 






" "" T "i: ::i: 


•• "•• c :::s"::!::::::::::::::: 




•• Elbow R... __ _ _ '' __ 


V i 


» •• l..: __„!v— --^-— — 


T i 




i • 


" " L. « rr -- 


T ! T ■ 


" Wr.atR... """rr-k- ~""- - ■■„ 


T 


•• . ■• l„. _ _ T7 


1 


Oepth Chest ' \.-~ ~' 


-p_ T T" it 




:-:.! ' 


Breadth Head _ mw! -r-~~ 


J trr 4 


" Neck..... _S_ „-.-'£' 




" Shoulders C*' 




" Waist.. '^^S;... 




.. H 1 „---~Z"~-'' '" 




Shoolder-tlbow R'. s s,_ V '» > 




" L. _ __,_ _ _ 


t~ " . _ " r~ " 


Eibow-Tip r """'"-->!: j 


+ -— J I . 


" " L 


1 T 


Length Foot R.... ^ v ^ **"■--„ 


T _ 


" " ••-- ■- - :v **' ' - *£-- 


T _. „_ T , 




:: _t:;;:;:i: 


Stretch of Arms .. 


" i tr 


\ 
Capacity Lunr;s... N, "" • ■ . _* 


rr t 


Strength Lunps.. 3 ' 


-=----, T L 


£«*.... _ = ----""*" A, 


",--" 


Lcr;s \ 


--="::::"- i r 


Chest... __ __ ^/_ 


.'. ---■*" " " 


" Upper Arms. 


1 i 


«c x ---------- 

" fore Armj. . v ^ 


: ------ -r 


Total.... „..-'' 




Development Ar ~""\ ---- — 


•---' i ~]\ i i 


Vision 


T 1 {It 


Hcar.ng 


I ""I ~~!l -HI 


t ____.___Tir:: 


:i±:±::i:::±tt::±t±_ 



Fig. 42. 



Copyright, 1886, by D. A. Sargent. 



Graphic Anthropometry. 97 

from so few records in many cases that there was con- 
siderable irregularity, and therefore after determining the 
apparent law of variation, the table was made to conform 
more or less closely to this law, and a better sheet for 
graphic illustration was produced. The numerical com- 
parison method that has been in use at Amherst for over 
thirty years has given us the most extensive study of 
young men from sixteen to twenty-five years of age that 
we have (see page 105). The tables compiled by Dr. 
Hitchcock are the most complete in existence in this 
country, the records all having been taken by one man. 
In 1888 the measurements of Yale students for five 
years, that had been taken by the author and that 
included every man in the undergraduate departments 
for three years and of two other academical classes, 
except three men, for four years, altogether the records 
of over 2, 200 men, were compiled and arranged in tabu- 
lar form according to the method of Mr. Galton (see 

Fig. 43). 

This has furnished a table for graphic illustration and 
personal information that is fairly complete. It com- 
bines (a) the comparison of a man's records with those 
of the whole mass of students ; {b) a comparison with 
the mean; (<r) the statement of the actual numerical size 
of each part of an individual, and (d) its relation to every 
other part. 

The general form of this table has been found to be 
more satisfactory than any other that has been devised, 
and it has been followed in form by Dr. Hitchcock, 
Miss Wood, and Dr. Hanna of Oberlin, and, with slight 
modifications, by Dr. Gulick (Fig. 44), Dr. Garland and 
Dr. Pfister. Dr. Baker of Washington and Jefferson 
College has also slightly modified the form, while main- 
taining its general features. 

This percentile table (Fig. 43), issued in the Spring of 

















































<T5 
<5Z 


v- 
g 






>o 

oo 
«0 


§ 


«0 


fM 


CO 




fM 


CO 




cO 
CM 


N« 


io 

co- 
CM 


NO 


cO 
CM 


CO 


00 
9> 


v* 

^ 


S 




ccj 
CO 


* 


CO 
CO- 
CO 


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cvi 


i 


co 


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si 


■»«. 

$ 


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CM 


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Id 


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CO 

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fO- 
CM 


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g 


** 

va 


a 

CO 


cm 


CO- 
CO 


v© 




cO 
CO 


«o 


CM 


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NO 

CM 
CM 


ua 


NO 

CM- 
CM 


id 


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ci 
CM 


CO 

vi 


i <=> 
GO 


co 


00 

>o 


^2 


*>0 

CO 


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CO 

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CO 


2 


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t 


CM 


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cvi 

CM 


id 


CM 
CM 


io- 


NO 

CO 


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3! 


V3 
CO 


Tv- 


CO 
co* 

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oo 


CM 
n© 

CO 


CO 
CO 
CO 


<0 


CM 


cO 


CO 


CM 


CO 


^ 


CM 


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CM 


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3* 


CM 


VO 
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CD 


3 


co 

CO 


tn. 


CO 
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CO 


M" 

CO 


CO 

CO 


^ . 




CO 


^ 


2 


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CM 


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3 

CM 


vt 


VO 


CM 


ra 




n0 
CO" 
>0 


v0 


CO 


CO 

CO 


CO 


^ 






^ 


$ 


CO 
<M 


<M 
cvi 




CM 
CM 




id 


CM* 




& 

2 


CO 

n© 




CM 

us 

CO 


CO 


Tn. 
ca> 
CO 


CO 

ci 


CM 


fM 


00 
CO- 


CM 


NO 


cm 


CO 


CM 


CO 


5 


CO 


1 l/Q 

i v9 


<3" 
i/S 


>o 




id 

cO 


CO 
CO- 
CO 


c5 
CO 


CO 

o 


«» 




CO 

ci 


^ 


»o 


CO 
ci 
CM 


CM 


CO 
ci 
CM 


CM 

vf 


co 

«o- 


ci 




erf 

3: 


a 


CM 


*n- 

* 


CO- 
CO 


cO 




-' 


3 


ci 


^ 


CM 


M> 

cj 

CM 


i 


nQ 

cS 
CM 


? 


lO 
c\i 


ci 


! I/O 


2; 


«<-3 

n© 


5 


UO 
CO 


CO 
N: 
co 


CO 
CM 


-0 

cb 


CO 


CO 
CM 


1 


CO 

o 


co 
CM 


5 

CM 


s 


S 

CM 


1 


cO 


vO 

oS 


; cd 

| WD 


Uo 
CO 




S 


CVJ 

CO 


CO 


NO 

<ri 

CM 


WD 

ci 


>• 
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CM 


**> 

ci 




c\i 


CM 
O 


CO 

cO 


a 

CM 


cO 
CO- 


"^ 


00 




in; 

CO 


no 


<0 


CO 


CM 
CO 


CO 
OS 

CM 


to 
o 


M> 


CM* 




NO 


CM 


"2 

CM 


I- 

CO 


o 
CM 


IN. 
CO 


CM 


CO" 




io 
«o 

CO 


N 
no 


cO 

<o 


CO 

CO 
CO 


CO 

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CO- 
CM 






2 


ca 


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to 

00 


NO 

fO 


OO 

co 


vO 
cri 


00 


00 




«o 

cO' 

CO 


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n9 




«0 
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CO 


NO 

<0 


CO 
CM 


CO 
c5 


CO 


CO 


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ci 


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CO 


crt 


"2 


Tn» 

CO 


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cO 


c6 


CO 
tv* 




CO 
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CO 


CO 
CO- 
CO 


CO 

CO 


CO- 
CM. 


CM 
O 


o 


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CM 


CS 


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CO- 


CO 
CO 


CO- 


CO 

fO 




M) 




CM 


CO 

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co 


CO 
CO 


CO 


CM 
CO- 
CM 


cS 


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ci 


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CO 

oo 


CM 
cO 


CO 
CO 


CM 
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i> 


NO 


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M- 

CM 


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CO 


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CO 


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CO 


CO 

is: 

CVJ 


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CO 


CO 


d 


CO 

oo 


CO 


5 


CO 


CO 


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NO 


CM 

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CO 


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cm 

«o' 
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co 

05 


>o 

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CO 
00 


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< 


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CO 


cd 


CO 
cd 


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co 
2 


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co- 
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0) 


ci 


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tNi 


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CO 


CO 
CM 


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N 


GVJ 


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n0 


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v. 


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i 


OCT 


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Oct 


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-XL 











































IOO 



Graphic Anthropometry. 



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1 888, was followed in 1891 
by a similar table compiled 
from an almost equal num- 
ber of men by Dr. Hitch- 
cock of Amherst College 
(Fig. 45). This table gives 
an opportunity of compar- 
ing the average or mean 
Amherst student with the 
mean Yale student, as each 
table includes all of the 
group at each college. 

It should be remarked 
that in recording certain 
dimensions the method 
varies so as to invalidate 
the comparison for these 
items. For instance, the 
height of knee in the Yale 
table is the height to the 
top of the head of the 
fibula, while in the Am- 
herst table it represents 
the height to the tendons 
of the hamstring muscles. 
The girth of elbows repre- 
sents in the one case the 
smallest measurements 
taken above the condyles 
of the humerus, while in 
the other it represents a 
measurement taken over 
the condyles. And in 
breadth of shoulders the 
record in the one case is 
bi-acromial, while in the 



Fig. 45. 



Graphic Anthropometry. 101 

other it is bi-deltoid. It should also be noted that the 
strength records are taken with entirely different instru- 
ments, and therefore do not represent so close a compar- 
ison as do the other records in the table. In the strength 
of forearm on the Yale table the upper figures represent 
the readings on the dynamometer, which were supposed 
to be kilograms and were so marked ; while the lower fig- 
ures in the square represent the actual value of these 
records in pounds, as determined by a test of the instru- 
ment. This instrument was of standard make, and illus- 
trates the unreliability of spring instruments, that have 
been used heretofore in securing records. The double 
sets of figures in the various squares in all these tables 
represent kilograms, millimeters and liters and their 
respective equivalents in English units. 

In 1893 Miss M. Anna Wood of Wellesley College tab- 
ulated the measurements of 1,500 students, and issued 
the table, Fig. 46, in the same form as that of the 
author. This was followed in 1894 by a similar table, 
Fig. 47, compiled from the records of 1,600 female stu- 
dents of Oberlin - College, taken and compiled by Dr. 
Delphine Hanna, a professor in the college. The order 
of items follows the Wellesley form. In both of these 
cases the tables are of high value as representing the 
whole of a group, and we may therefore fairly consider 
that the fifty per cent line represents the average of the 
students of Wellesley and Oberlin. 

An interesting study of the physical type represented 
in the two institutions may be made by plotting the fifty 
per cent line, the twenty-five per cent line above the mean 
and the twenty-five per cent line below the mean of one 
college upon the table representing the records of the 
other. In general it will be seen that the Wellesley 
student is somewhat larger in general dimensions, while 
the Oberlin student represents more nearly the type that 



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104 Graphic Anthropometry. 

has been popularly attributed to the Yankee. A com- 
parison of these tables suggests a possible influence of 
environment in producing a racial or local type, for in 
general, the ancestry of the Ohio pupil is the same as 
that of the Wellesley pupil. It is possible also that the 
early occupations of these students have differed so 
widely, as also their food supply, as to produce the modi- 
fications noticed. It should also be borne in mind that 
the personal equation or method in taking the records is 
marked in the results seen. 

In 1893 Dr. Hitchcock of Amherst issued a table made 
up of a determination of averages on the basis of heights ; 
that is, he grouped the records of 1,322 students between 
the ages of seventeen and twenty-six years, according to 
the height of the individuals, separating the groups 
according to a gradation of one centimeter. His records 
varied from 160 to 183 centimeters. He found the aver- 
age for each one of these groups and arranged them as 
seen in Fig. 48. 

The nearest approximation to the general college aver- 
age is found to be the grade representing the averages of 
men from 172 to 173 centimeters in height. It may be 
said that this table gives us the best standard of the 
various dimensions that are characteristic of American 
young men between the ages of seventeen and twenty- 
six. The arrangement of the figures in the squares is 
the same as that used in the percentile table. This table 
cannot be used for graphic illustration so successfully 
as can the percentile table, although for men of nearly 
the mean dimensions the table is satisfactory for this 
purpose. In the use of this table it is believed that a 
method suggested by Dr. Kellogg in a chart (see Fig. 49} 
issued in 1895 could be used to advantage, for it combines 
a high value for graphic purposes, with the reliable 
standard afforded by an arithmetical mean determined 



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Graphic Anthropometry. 107 

for men on the basis of their varying height. The fallacy 
of the supposition that a percentile grade represented a 
standard for an individual, as claimed by some, has been 
pointed out by Dr. Gulick, Dr. Boas and others. Here, 
however, we have the standard determined by mathe- 
matical treatment of the records of persons of the same 
height, and the person may then be graphically repre- 
sented in the same way that he could be represented on 
a percentile chart made up from the measurements of 
persons of his own height. This introduces a new and 
important feature into graphic anthropometry, and one 
table becomes available for representing any individual 
within the limits of the tabulation. 

"It is a recognized law that the strength increases in 
proportion to the square of the height, whereas height 
increases in simple arithmetical ratio. In order to fur- 
nish a basis for a more just comparison two charts have 
been prepared upon the basis of height, including such 
heights as fall within the limits of 58 and 67 inches for 
women and 63 to 72 inches for men. Provision is made 
for a graphic percentage representation in the diagram 
occupying the lower half of the chart, upon which per 
cents may be written at any level from o to 250. To 
obtain the percentage relation of the person examined to 
the mean-average person of the same height, it is only 
necessary to divide the number found for each individual 
group of muscles by the number shown in the proper 
columns for the mean-average person of the given 
height. Having found the percentage in this manner, 
a dot is made with a pencil in the proper column, and at 
■a level corresponding with the percentage shown by the 
quotient obtained. If the quotient is 1, the dot will be 
made opposite, or in line with 100, and the meaning is 
that the strength of the group of muscles tested is equal 
to that of the mean-average person of the same height. 



jo8 Graphic Anthropometry. 

If the amount obtained by dividing the number found 
by the number representing the strength of the same 
group of muscles in the average person of the same 
height is less than i, as .50 for example, this repre- 
sents that the strength of the group of muscles examined 
is only one-half, or 50 per cent, that of the mean- 
average person of the same height. A dot is accord- 
ingly located opposite to, or' in line with, the num- 
ber 50 in the per cent column. In like manner, points 
may be located for each group of muscles. Con- 
necting the points by lines, we have a graphic represen- 
tation in which the relation of the individual examined 
to the mean-average person of the same height is accu- 
rately shown (Fig. 49). All the points in the chart which 
fall below 100 indicate relative inferiority of strength;, 
all the points above the 100-line represent relative 
superiority in strength." 

In considering these percentile tables taken from the 
records of college students it is well to bear in mind 
several points. First that the percentile table does not 
furnish us a working type or model of proportions in its 
fifty per cent line, but it is rather a statement of the 
actual physical size of the college community at the time 
these records were gathered. Very few of the records 
entering into the compilation represent physical matu- 
rity, although this is more nearly true of the tables for 
women than for men. It is a notorious fact that a large 
percentage of college students have received no adequate 
physical training or exercise before reaching college. 
Their lives have been abnormal and unnatural in that, 
during the playing period of their lives, they have been 
closely confined to a line of mental processes that dealt 
largely with abstract subjects and that deprived them of 
physical activity. As a result of this method of life mus- 
cular sizes must be abnormally small in the great majority 



Graphic Anthropometry. 109 

of cases, and a table constructed from such measure- 
ments will show a man that is truly "mean." To deter- 
mine so far as possible the variation of the fifty per cent 
line on the table of Yale measurement from what might 
be expected in a similar table constructed from the meas- 
urements of men of a like age but who had taken a large 
amount of physical exercise, and who could be consid- 
ered in perfect health, I selected five hundred individ- 
uals from two thousand and grouped their measurements 
.according to the percentile method. The results are 
shown by the lines representing the twenty-five per cent 
grades, as well as the mean, that are plotted on the reg- 
ular table as shown in Fig. 43. It is believed that this 
new fifty per cent line represents a much more reliable 
standard of physical excellence than the line represent- 
ing the mean of the whole college community. 

A glance at these lines shows us several facts : First 
— That the relation between bone size and muscle size 
varies in different types of men, viz. , in the short person 
the muscles have a much larger proportional size than 
in the tall person. This has been demonstrated before 
in other ways and formulated into a law that the work- 
ing power of a muscle varies as its cubical contents. 
Second — That there is a direct ratio between exercise 
and bone growth. The lengths of leg in all these cases 
plot higher than length of trunk. Third — A high devel- 
opment seems to declare itself in more increase of depths 
than of breadths. Fourth — That there is a direct ratio 
■between size of muscles and capacity of lungs. Fifth — 
That girth of waist increases with chest and hips but not 
in the same proportion. Sixth — That high nutrition 
power is essential to high development." Seventh — That 
muscular and nervous strength increases in greater pro- 
portion than other items; so we may infer that high 
strength tests indicate physical welfare. Eighth — That 



iio Graphic Anthropometry. 

exercise gives a measurable increase in stamina and 
tends to produce a distinguishable type of man. 

Dr. Enebuske has developed into a new form the more 
important indices as a basis for graphic use in showing 
the physical condition of a person (Fig. 50). In this- 
graphic diagram Dr. Enebuske presents a curve, a, 
representing an individual who was too weak to be 
admitted to class work in the school ; curve b represent- 
ing the weakest student who was admitted to the normal 
class of the school; curve c representing the average 
working capacity of 1,100 female students of Wellesley 
College, from data furnished by Miss M. A. Wood of 
Wellesley; curve d on the chart shows the average of 
the students entering the school before the beginning of 
their gymnastic training; curve e shows the average of 
forty-two graduates of the school of an average age of 
twenty-three years ; curve / represents a record of a 
student whose working capacity corresponded most 
closely to the average working capacity of the gradu- 
ates ; curve g represents the highest record made by all 
female students up to the date of the paper; curve h 
represents the average Amherst student ; curve i repre- 
sents a male student of the Normal School of Gymnas- 
tics; curve/ represents a Yale student of the 50 per cent 
grade. This curve represents also the average of fifty 
naval cadets of the U. S. N. Curve k represents the record 
of a male student of the Normal School of Gymnastics, as 
does also the curve /. This form of chart is used in 
the Boston Normal School of Gymnastics as a test of the 
physical condition of the students, who are examined 
monthly, and if the curve at any time falls below what 
may be expected from the previous record the conditions 
of work are examined, and so far as possible errors of 
method are corrected, or, failing to find such errors, the 
pupil is relieved of part or all of the work until a physi- 




H = Height (centimeter). 
W -Weight (kilo.). 
LC =■- Lung capacity (liter) 
TS = Total strength (kilo.). 

Wh=- Weight-height index 

V = Vital index (— ). 

S*i>-- Strength-weight index ( ^ ). 

V-;w = Viral Strength-weight /LC , TS 

Po* Power index (tS^£) 



Copyright ly the Boston Normal Sehoot 
of Gjrntnaittfi, t&Qj 



ii2 Graphic Anthropometry. 

ological condition is reached that will bear the severe 
work of the school. 

With the invention of the Kellogg dynamometer and 
the consequent ability to test more accurately special 
groups of muscles, we have put at our disposal a means 
of extending the study of ratios between the size of vari- 
ous parts and their working ability, and this ratio may 
obviously be expressed in the form of an index or co- 
efficient ; and thus it is believed that the graphic chart of 
the future that is to give an individual a clear concep- 
tion of his standing as a member of the community must 
show him his relation to others, not only in size but in 
working capacity. And a closer study of method will 
give us coefficients that shall also indicate the quality 
of work, as well as its quantity. Not until this point is 
reached can anthropometry be said to have fulfilled its 
mission. 

In connection with the arrangement of the percentile 
charts of strength tests there has been a study of the 
relation of strength to weight and to height, and for the 
mean, the strength weight index, as determined by Dr. 
Kellogg, is 37.34 for men and 23.42 for women. This 
index as determined by Dr. Enebuske is 7.5 for men and 
5 for women. The difference being due to the larger 
number of tests used by the former. The ratio is essen- 
tially the same, thus establishing the comprehensive 
character of the ratio. The relation between weight 
and lung capacity is probably more definite than the rela- 
tion between height and lung capacity, because weight 
is a definite statement of the amount of tissue to be sup- 
plied with oxygen, while height relates simply to the 
arrangement of the mass, rather than to its amount. 

The statement that for each increase in height of 25 
mm. we should expect an increase in weight of one 
kilogram relates only to the general proportions existing 



Graphic Anthropometry. 113 

among men, whereas the average weight of a transverse 
section of 25 mm. would undoubtedly be greater than 
this amount. But respiration is physiologically a meas- 
ure of the cellular activity of the body, rather than of 
the number of its cells, and therefore we should 
-expect those cells that undergo rapid metabolism, and 
that consequently tax the respiratory function for both 
the supply of oxygen and the elimination of their carbonic 
oxide, to bear a closer relation to lung capacity than 
would total weight. Muscular tissue stands at the head 
of all cellular structure in the vigor and continuity of 
its activity, glandular structure being the only tissue 
that compares with it in the violence of its metabolism. 
But glandular activity is periodical and fairly uniform 
among all persons, the processes being primary and vital, 
while muscular activity is secondary and voluntary. It 
would seem, then, that muscular size must be the meas- 
ure of lung capacity. Now strength is the expression of 
muscular size and activity {i. e., nerve stimulation), and 
therefore the relation between strength and lung capac- 
ity must be a definite and measureable one. 

The relation between strength and height cannot be 
direct, although some coefficient may be determined 
that shall express it with a fair degree of accuracy; but 
the mere expression of height, without relation to weight 
or girth records, tells nothing of the muscular size, and, 
as we have seen, this and its related nerve influence is 
the determining factor of strength. That tall people 
are on the average stronger than short people does not 
refute the argument already stated, because in general 
tall people are also heavier and larger in girth than short 
people, and consequently their muscle mass must be 
larger. 

The relation between strength and girth would seem 
to give us a coefficient that would be fairly reliable and 



ii4 Graphic Anthropometry. 

constant, especially if we include in the girths only the 
girths of the limbs. The reason for this exclusion will 
be obvious if we consider for a moment the fact that 
limb development cannot be secured without a simulta- 
neous development of the muscles of the trunk, as the 
muscles of the limbs are directly connected with the 
trunk, and any phase of their activity is accompanied 
by a responsive contraction of some group of muscles to 
steady the trunk for the support of the force that is to 
be exerted by the movement of the limb — the trunk 
being a fulcrum, as it were, for the lever constituted by 
the limb. Yet the trunk girths may be large from 
accumulated adipose tissue and the limb girths be com- 
paratively small, owing to habits of inactivity and scant 
muscular exercise. In other words, we may have large 
trunk girths and poor limb girths, but not the reverse. 
The limb girths, then, are a fair measure of the muscu- 
lar activity of the individual, and consequently may be 
truly said to bear a definite relation to the strength of 
the individual. It has been noted as an anthropological 
fact that in the more highly developed races of men the 
increased size and development of the legs is a charac- 
teristic feature. 

If we consider a ratio of height to weight we have an 
indication of the excess of storage tissue or of the scant 
development of the soft tissues and therefore have a co- 
efficient that must bear a fairly close relation to strength. 
This relationship could be expressed by another line on 
the chart of Dr. Enebuske and wide divergence from 
the normal lead of anticipation of poor condition of work. 

A breadth-strength coefficient, or a depth-strength 
coefficient, would apparently be unreliable for the same 
reasons that operate against a strength-height co- 
efficient. That is, we may have breadth representing a 
•possibility for muscular attachments, and still these mus- 



Graphic Anthropometry. 115 

cles may not be properly developed, while in the case of 
depths, the large upper trunk depth would indicate an 
approximation to the round type of chest, which is prim- 
itive and not compatible with large lung capacity ; while 
large depth of the lower trunk is indicative of muscular 
weakness or insufficient oxidative power. On the other 
hand, small depth of chest may be coincident with exces- 
sively poor muscular development or with a fair degree 
-of muscular development and large respiratory power. 
It would seem, then, that neither of these measurements 
could be depended upon as a basis for determining co- 
efficients. 

In 1889 Dr. W. L. Savage devised a chart for use in 
plotting the measures of boys and youths. The scheme 
is very ingenious and will be found generally useful 
when the table on which it is based is placed in the 
hands of instructors. The chart can be used for any age 
and gives absolute record of averages rather than com- 
parative. These averages are computed for all ages from 
one to twenty years and arranged in concentric circles. 

In 1890 the most completely graphic method that has 
yet been devised was completed by Dr. E. Hitchcock, Jr. 
It is based on the tabulation of ic,ooo sets of measure- 
ments — all made by physicians who were experienced in. 
the work. The figure is drawn from the average of the 
various measures, and lines to right and left show in a. 
perfect manner the relation of girths as they are actually 
found to exist. The relation in size of limb girths to 
semi-girths of the trunk have never been so clearly 
demonstrated before, and therefore the chart is an impor- 
tant contribution to artistic anatomy. 

The numerical method of comparison has been the one 
in most general use because the data necessary for mak- 
ing a graphic picture of a person's anatomical proportions 
has only recently been made public. The advantage of. 



n6 Graphic Anthropometry. 

a graphic illustration of physical proportions is as great 
as the advantage of that method in any department of 
scientific work. It discloses at a glance what is discov- 
ered only after considerable time spent in study of fig- 
ures. It would seem that the union of the graphic and 
numerical methods of stating the proportions of an indi- 
vidual must be more comprehensive than either method 
alone, and more satisfactory to both instructor and 
student. 

The use of photography is a legitimate application of 
graphic principles and it will soon be employed in all 
gymnasiums where scientific study and accurate work is 
accomplished. It gives an idea of the form of a man 
that cannot be derived from figures or graphic lines, and 
will therefore show results of exercise that figures can- 
not express. 



CHAPTER VIII 



THE LAW OF GROWTH. 



The presentation of the law of growth has been accom- 
plished in various ways. The underlying- principle, how- 
ever, in most of these methods, depends upon the approx- 
imation of any group of measurements to the binomial 
curve, as first demonstrated by Quetelet. The measure- 
ments may be grouped into symmetrical grades accord- 
ing to the percentile form, or they may be grouped into 
gradations or series according to some common unit, 
as, for instance, the weights may be grouped according 
to the grades representing kilogram or other variations 
from birth to maturity, and heights may be graded by 
using the centimeter, etc., as the unit, and all the meas- 
urements graded from the shortest number at birth to 
the highest number found at maturity. This latter 
method has been followed by Dr. Beyer in his compre- 
hensive brochure on the growth of the United States 
naval cadets, where he also combines it with the percen- 
tile method. Records may also be grouped according to 
their relation to some particular part that may be taken 
as a unit or modulus for the other measurements. This 
method has recently been followed by Dr. W. S. Hall in 
a paper* on "The Changes in the Proportions of the 
Human Body During the Period of Growth, ' ' where he 
considers the total height of the body as the modulus,, 
and gives the sizes of the other parts in fractions of the 
total heisfht. This method also may be combined with 
the percentile method, as shown by Dr. Hall. The 

* Journal of the Anthropological Institute of Great Britain 
mid Ireland. Aug., 1895. 



n8 The Law of Growth. 

scientific value of this latter method depends on the 
proportional contrasts that it presents between parts 
at various stages of growth, as it has long ago been 
proved that there is no fixed relation between the 
proportions of the various parts of the body. Finally 
we may have the method of arithmetical means or aver- 
ages. This method is applicable to a wide range of 
investigation and gives us a result which is essentially 
the same as the fifty per cent line in the "percentile" 
method, and the mean in the method of "probabilities" 
and the "most frequent value, " if the material consid- 
ered is homogeneous. 

As shown by Quetelet the method of averages can be 
applied to material that is small in amount and that is 
not uniform, while the method of means can only be 
applied to uniform material. The material represented 
by a group of men in an American college cannot be con- 
sidered homogeneous and for this reason certain men 
like Dr. Hitchcock of Amherst have preferred to use the 
average methods in tabulating their data. A selection 
•of material according to ages in these groups of college 
statistics is still open to the objection that the individ- 
uals represent mixed racial types, and consequently the 
curve showing the frequency of occurrence of values will 
not conform to a true, binomial type. It has been 
shown by Gould in his report of the sanitary commission 
that the men from certain regions, notably Tennessee, 
Kentucky and Indiana, are of taller type than were 
found in other sections, notably New York, New Jersey 
and Pennsylvania. Obviously a college that contained 
a large number of students from any one of these local- 
ities would have the height curve seriously modified, and 
the height of most frequent occurrence might be changed 
without changing the average appreciably. The aver- 
age height of students in the various colleges illustrates 






The Law of Growth. 



119 



the fact that there is a difference in type in different 
parts of our country. This may be seen by reference to 
the percentile charts of Wellesley and Oberlin women 
(Figs. 46 and 47.), and by Fig. 51, showing the height 




Fig. 51. 



120 The Law of Growth. 

and weight of boys. The upper group of lines repre- 
sent heights and the lower weights. The solid line is- 
from Bowditch; the dotted line Peckham; the dot and 
dash Gilbert, while the two dots and dash show the 
median values for New Haven boys. 

When, however, the measurements are arranged in 
percentile grades as suggested by Galton, while the 5a 
per cent line does not have the authority of the average, 
it is not the only feature of the compilation. This fifty 
per cent line as before stated is found to be essentially 
the same as the average, where the group considered is 
homogeneous, and in addition to the determination of this 
value we know how all the records are distributed. As, 
for instance, we may say that one per cent of all the records 
in any given item were as large as the number found in 
the corresponding grade at top of the table, or as small 
as the number in the grade at the bottom of the chart. 
It also enables us to trace the variation in the group and 
discover by the departure from the binomial curve the 
presence of any material that is not homogeneous. It 
being assumed and fairly well demonstrated that there 
is a mean around which all human proportions are 
grouped in symmetrical forms. 

The so-called binomial curve depends for its determi- 
nation upon the coefficients of a binomial quantity, as x 
-4- y raised to any given power. The numerical value of 
the coefficients may be represented by lines, Fig. 51, and 
if these lines be arranged parallel to each other on a 
common base and a line drawn connecting the tops of 
the adjacent lines, we shall have an approximation to a 
curve, and this approximation will be rendered more 
complete the higher the power to which the binomial 
quantity is raised. For instance, if we raise x -p y to 
the tenth power, we shall have for coefficients 1, 10, 45, 
120, 210, 252, 210, 120, 45, 10, 1. The middle line is the 



The Law of Growth. 



mean around which the others are grouped in symmetri- 
cal order. This form of distribution is found in the 
arrangement by chance of all quantities of similar 
objects. For instance, if an equal number of black and 
white balls be placed in a box, thoroughly mixed, and 



Fig. 52. 

drawn by chance, in groups of ten, 1024 times, which 
is the sum of the preceding coefficients, it will be found 
that once all ten balls will be black, once all will be 
white and the various coefficients in the expanded bino- 
mial will represent the number of times that the balls 
would be drawn in the relative proportion of black and 
white that is indicated by the relation of the exponents 
of the two quantities in each term of the expanded bino- 
mial. The sizes of men in the community who have a 
common ancestry and a common environment tend to 
group themselves in exactly this same order about a com- 
mon type or mean. 

If now we group any number of measurements of a 
dimension, as of height, weight, etc. , in order from the 
smallest up to the largest, dividing them into as many 
equal divisions of size as our expanded binomial has 
terms, we shall find that the numbers in these groups 
are represented graphically by the height of the lines. 



122 The Law of Growth. 

as in Fig. 52. It is obvious to any one that instead 
of dividing into these eleven arbitrary divisions we 
might divide them into twenty divisions or a hun- 
dred, according to the gradations of size. If one 
hundred were made the basis of the division we should 
then have the records grouped according to percen- 
tages, as was suggested by Galton. This grouping has 
been found the most convenient that has yet been dis- 
covered, for it determines not only the mean, which in 
any uniform data will be the same as the average or 
arithmetical mean, but it determines the mathematical 
relation of any point in the curve to the mass of material 
represented by the balance of the curve. 

Dr. Boas has called attention in a paper published in 
the report of the American Statistical Association, 1893, 
to some of the causes that prevent the distribution of 
physical measurements according to the strict law of 
chance. He mentions the failure in the uniformity of 
ancestral type with a multiplicity of type in the offspring 
represented by the data ; in other words, there is a lack 
of homogeneity in the data to be tabulated. He also 
mentions the lack of uniformity in growth at the various 
periods, and such material must evidently be considered 
by some calculus of variables rather than by the simple 
binomial law. He prefers the method of mean varia- 
tion for statistical purposes. In the percentile grade sys- 
tem of tabulation we have certain misleading features 
that should be noted by all persons who make use of it 
for graphic purposes. For instance it is often assumed 
that the line of any percentile grade represents an indi- 
vidual or what an individual ought to be. This fallacy 
results from the association together of data that have 
no relation to each other. Each column of figures being 
arranged solely with relation to one dimension. If, for 
instance, we consider the column representing total 



The Law of Growth. 123 

height, and then compare with it two other columns 
which bear a tabular relation to it that is constant, 
namely, the height sitting and the height of pubis, which 
gives the length of legs, we would find that if the measure- 
ment of any individual be applied to this percentile chart 
and the total height fall upon the thirty per cent line we 
would have no right to assume that the height sitting 
would fall upon the same grade, for it may fall on the 
fifty per cent grade or on the ten per cent, etc., the total 
height, being made up essentially of the two records con- 
sidered, may be the sum of one short and one long ele- 
ment so that if the height sitting fell upon a higher 
grade than the total height the length of legs would fall 
upon a lower grade and vice versa. In fact, the proba- 
bility of the two height elements falling on one grade is 
strongly against its occurrence. 

The interrelation of other proportions may be even 
less distinct than the case mentioned. In studying the 
growth of different individuals, it would seem that a 
general law of growth cannot apply to all cases ; and that 
even the application of a law determined for any type as 
suggested by Dr. Porter, has wide limitations, for the 
relation between the bone growth and muscular growth 
of tall boys is not the same as between the bone and the 
muscle growth of short boys. In the period of acceler- 
ated growth from twelve to fifteen years of age the 
increase of bone lengths is markedly greater than the 
increase in muscular tissue* (this will be seen by refer- 
ence to the tables of Dr. Bowditch, Dr. Porter and 
others, if we assume that weight is a fair index of the 
growth of the muscular parts), while the period from six- 

* This observation has been formulated by Dr. W. S. Hall as fol- 
lows: "When the vertical dimension of the body is undergoing an 
acceleration of its rate of growth the horizontal dimensions undergo 
3. retardation of their rate of growth, and conversely." 



124 The Law of Growth. 

teen to twenty-three is a period of comparatively slow 
bone growth and of rapid muscular growth, just as in the 
decennial period from forty to fifty the marked increase 
in weight must be attributed to storage tissue rather 
than to either bone or muscle growth. It would seem 
to be important then that some investigation should be 
made to classify the data according to the general type 
of individual that they represent, and from this classified 
data determine anew the law of growth. 

It should also be borne in mind that the rapidity of 
growth varies in the different sections of the country, 
apparently according to climatic and telluric conditions. 
Another factor to be considered in the study of anthro- 
pometric data is the personal equation that is charac- 
terstic of each individual when working with more or 
less plastic material. This will be especially noticeable 
in the records of girths and breadths, where slight vari- 
ation in tension occasions a wide divergence in records. 
Attention should also be given to the important matter 
of having a record of all of the group in order to make 
the records reliable for tabulation purposes. If, for 
instance, a percentile chart be arranged from the meas- 
urements of such students as offer themselves for exam- 
ination in a college where the examination is optional 
with the students the grades will not conform with any 
fair degree of regularity to the binomial curve, because 
in general two sets of men will offer themselves for 
examination. First the athletic group of men who are 
well developed and are proud of the physical record 
that they can make, and who may wish suggestion as to 
further improvement. The second group will be made 
up of physical wrecks who find themselves unable to do 
the college work without much physical hardship and 
who are in hopes of receiving such hygienic suggestions 
as shall enable them to continue their work. Between 



The Law of Growth. 125 

these two groups will come a few men who more truly 
represent the ordinary student and whose influence on 
the chart should be the dominating- one. If, then, we 
are to tabulate by the generalizing method we must have 
a large mass of material that shall have been gathered 
in such a way as to have the errors and the omissions of 
one group balanced by the data supplied by another 
.group, and in the final tabulation it will probably be 
found necessary to treat the resulting curve mathematic- 
ally in order to establish the true values for any given 
.grades. When, however, the whole of any group is 
measured, and by one person, a comparatively small 
number of persons will be found to exhibit the type and 
the general distribution of the records for all such per- 
sons. Thus it is found that a percentile table made 
from the records of five hundred college men of the 
same age (within the limits of one year) that includes 
all the men of that age in college at one time, will repre- 
sent a closer approximation to the binomial curve than 
will the record of 2,500 men of similar ages gathered from 
year to year under the optional system of physical exam- 
ination. 

In studying the law of growth attention is called to 
the chart prepared by Schuyler B. Moon of McDonogh, 
Md., as shown in Fig. 53. This table is made by group- 
ing the measurements of one hundred and fifteen boys be- 
tween the ages of thirteen and fourteen years according 
to Galton's percentile method. The 50 per cent column 
represents what we may call the mean, and for the sake 
of comparison the 50 per cent lines from four other 
charts, prepared by the same author, are graphically rep- 
resented on this one. The first line beginning at the left 
represents the mean of boys between eleven and twelve 
years of age. We notice that the items of height and 
length, the two being similar dimensions, diverge farther 



126 



The Laic of Growth. 



ANTHROPOMETRIC TABLE. 
McDONOGH SCHOOL, McDONOGH, MARYLAND. 



Compiled from the Measurements ol 115 Boys between the Ages of 13 and 14 years. 

By Schuyler B. Moon. 

Arranged according to the Percentages indicated at the top. Units : Years, Kilograms, Millimetres, and Litres. 

PERCENT.. s 10 IS *o *5 30 35 40 45 5,0 55 60 65 70 7s io 85 p 

AGE .3.1 13.1 13.1 13.* 13.3 13.3 13 j 13.3 13.3 13.J5 13.5 13.6 13.6 137 13.8 13,8 ij.8 Ij.i 

WEIGHT 37.9 19JJS^ 30 3 3> 4 3>-7 3>*| 33 2 33* 34b 34-8 35.3 35.8 36.4 37. 

HEIGHT 133V-13S713S2 "385 >39« 139S MOJJ ML5 >4>8 143} 144S 1450 14*1 1466 1475 ^ 

Knee 3*4^357 3*4 3*8 373 3*C^8o 38a 383 3S7 390 393 393 

Silting 693 :?»► 710 713 7«7 7" 7S» 73» 734 74P 744 748 75a 759 «tg^775 783 795 

Pubic Arch 659^^79 6S6 691 696 698 7* ;u 713 7^ 7»S *3» 737 740 74«7>~->«6 767 

Navel 799/815 8j6 83a 840 84a S43V853 861 S5r 873 S77 8Sa 886 89a 899 S^, 9 jj 

Sternum 1^77/ n w mn itw ua: 1135 113a ih(o 1150 116J 116S 1176 1178 1186 119a lao^^rfu 1146 

GIRTH " , ^V 

Head 51a 515 Ji8 533 sa6 5»8 53oJj2T^3»i> 53J 536 537 ^»2^S4I 54* i; 

Neck 361 a64 367 870 aji— ^73 — 373 *T%Jin 27* 'So aSo aSa 

Chest repose . . 644 657 666 totr^brf 6S9 69: i/fjf 70a 707, 710 713 7aa 7a6 73 , 

Chest full 6S1 69a 700 4^15 720 ra7 7iC«755 738 74> 745 75» 757 7*8 72* 786 795 803 

9tli Rib repose... 5SS 60a 609 617N 603 6»9 635 6jT>-643 64^ 650 655 66a 665 .1*74 6S» 685 

9th Rib full 641 654 661 6731^678 684 690 .ew 70a 70J 709 713 719 731/734 743 

VVnisl 55S 364 569 575^^^> 591 S98 60^ 60S 6i» 616 6ai 6as <^6^ 644 

Hips 64S 659 67a ^7S6S6 690 694 /76a 707 7'f »** 7a6 7a8 734 742""~7J» 766 

R. Thigh 364 37a 378 jfc 391 394 396X 400 404 40B 4'0 411 416 4*» 4*f - 43» 440 

L. Thigh 564 370 377 3j^ 388 39« 4jg6399 400 406 409 4" 416' 419 4*3 430 438 

R Knee 373 179 aSi 1^85 389 390 a94^>5 300 y» 30a 305 308 313 3 i 318 3*1 

L. Knee 373 378 aSo 1*86 aS8 293 v^*fl 299 3°} 3©3 305 308 3« 3A 311 ja6 33 

R.Calf 353 337 a6a a66> 270 374 376^380 aSi as| aS4 387 aS8 29a 2931 301 307 jrjj 

L. Calf 254 257 »*1 **7 | 271 *74 27sJ^T7 »8i aSJ 3S5 287 390 293 296 

R. Ankle 169 173 176 180 V183 "85 iSf^tij 189 19b 190 19a 195 196 198 1 304 aog 

L Ankle 17a 177 1S0 18a ^Jr 1S4 185 i8v 190 19I 19a 195 198 200 202^)204 210^215 

R. Instep 193 195 197 isTaoo 202 203 ao} \ftij 308 310 314 316 ^18 220 n^ 229 

L. Instep 190 193 »9«^J97 198 199 *» 201 2J3 aoR 205 207 210 313 

R. Upper Arm ... 196 198 201 \. »! 208 Jio 212 ^14 »l> 217 220 222 226 ^31 234 

L. Upper Arm .. . 192 194 198 200^^2 205 206 208 2o^^»b 212 213 230 aai iy 339 334 j 

R. Elbow 179 1S3 iSs 1S7/190 193 19a i««--"i95 itfc '97 »99 *» 203 aoX 208 214 218 

L .Elbow 178 180 1S2 K^iiK, 1S7 1S9 <^i 192 195 194 195 «97 198 *>$) 206 209 

R. Forearm 191 195 196 198a**- 201 203 205^^6 aofe 210 211 314 216 

L. Forearm 1S8 J91 193 195 j¥> '9 s 200 y/C 303 204 205 206 208 2:3 aU 319 223 

R. Wrist 129 130 131 >J5 134 133 '3* A38 >39 '$ 140 >4I 142 144 »45^ «47 150 154 

L. Wrist 127 l»9 "30 ijj 133 133 134 «3JL 137 13 s '39 140 Ml 143 

DEPTH : X. ^"V. j 

Chest 140 145 149 'So 150 N -~44J15 6 "57 158^89 «*° >*» 163X166 169 

Abdomen 143 MS M6 U9 IS' 154 >S»>1S9 'Q> »*» ,6 3 1*4 )t* 167- 168^275 

BREADTH: \ 

Head 140 141 142 144 145 146 146^M7 14? 14^ 149 149.150 ijo i«Q. Iji 

Neck 87 8S 89 89 so^ar-^l oT 93 9J3 94 94^>« s 96 96 

Shoulders 314 319 3»i ^^"328 332 333/335 337 339 342 344 345 ^^> 354 35* 3*' 3< 

Waist 196 200 303 3^ 208 310 2^ 314 315 31^ "8 220 221 ^ajt 226 228 233. 

Hips 236 241 244 -^47 250 253 254x357. 359 281 263 265 266 26S^3j». 274 279 a* 

Nipples 131 135 138 JJ$> 14a 143 144^J*6 147 149 15' 154 

LENGTH ^ ^^^ 

R. Should. -Elbow 2S1 j«8f290 296 297 <3» 301 30a 305 3°f 309 3» 3'4 315 3>7 >3» 334 339 

L. Should. -Elbow 278 J3S4 387 391 294 »«*1299 3°o 302 30U 306 308 311 313 314 3^9 333 337 

R. Elbow-Tip 35S I365 369 373 376 37938>| 385 387 3Sfe 391 395 396 

L. Elbow-Tip... 353 3^> 3*7 3TO 375 377 378^83 385 38^ 3S9 393 395 39 

R. Foot sis ^» a3i 334 335 336 337 1»8 339 330 331 333 335 

L. Foot 314 \i 213 "4 aas 337 337 3»S 330 33)2 233 234 236 237 Vvj4l344 246 

Horizontal 133 s <*^7S 138S "390 1399 ««0S 1441^ 143* 144* 1450 1460 1470 1475 1484SSOS, 1509 1543 ' 

Stretch." 1338 1370*>»44S7 1405 Maa 1431 rtifl 450 1457 14^5 1481 149' 1497 1507 iSJjV-ij'ao 1538 1360 

CAPACITY OF LUNGS l.jD L.74 lT77^*>apl . 90 I.9I 3V> 3.00 3 10 3Ig 3.17 2.30 3.38 

STRENGTH ^^^^^ I 

Lungs 7 9 10 10 lo_]>i lil 1.1 I.I l-|» !•• 1-3 '-3 

Back 6o.o 65.0 70.0 lirl-ft'oibp^fa .3 So.o 80.8 83.}) 83.0 84.0 86.0 87.0 89.* 

Legs 915 99-5 120.0 125^133. 8 <^o!o 146.3 153.0 158.8 165* 16S.5 173.0 C79-3 180. 5 183.0 1S6 

Chest.... 16.0 17.8 19.0 19.5 lo«iJiN9--aA^_^2 : o^23.o 23J0 240 25.0 35.. 

Upper Arm o .0 .0 .0 3.0 3^5 iT 'f'-T+Tn ' ' '" '3-4 i6-J> 

Forearm 12.5 14-5 15-l^J'J '* u ''' " i''*^ —- •*** ,8 )° ,88 

Total 194 8 3170 331.4 2JJ.8 2548i iV < 1 2^6 ^393X301.5 3" f 3160 320.3 J24-3 33' 4 33* 8 345^l35'- 



: 



Fig. 53. 



The Law of Growth. 127 

from the 50 per cent line of this chart than do the girth 
or breadth measurements, which shows a tendency in 
the growth of boys to increase in girth proportions more 
rapidly in early life than they do in length proportions, 
while at a later period the reverse is true — the lengths 
increase more rapidly than girths. This demonstrates 
fully the law that while girth measurements are accele- 

^ rated length measurements are retarded, and vice versa. 
The next point to which attention is called is the large 
girth of head, it approximating more closely to the stan- 
dard of a boy in his fourteenth year than any other meas- 
urement, showing that this tissue is developed compar- 
atively early in life, and that its percentage of future 
increase must be small as compared with that of any 
other measured organ. The breadth of head rising to 
essentially the same percentile grade as girth shows that 
the form or shape of head does not essentially change 
during the period of growth. Physiology has taught us 
the early growth of the brain that reaches a fair approx- 
imation to its final size in the eighth year. At birth 
it is 14.34 per cent of the total weight while in the adult 
it is only 2.37 per cent. The muscles grow from 23.4 
per cent of the weight at birth to 43.1 per cent of the 
weight in adult life, while the skeleton keeps at about 
the same proportional part of the total weight through- 

. out active life, ranging from 16.7 percent at birth to 15.4 
per cent at maturity. 

The next point to which attention is called is the large 
depth of abdomen and comparatively large girth of waist. 
This represents the infantile type and is followed, as will 

• be seen by reference to the two lines upon the right of 
the chart, by a period of retardation in growth. The 
chest, to some extent, partakes of the same change in 
type, and shows that the "round chest," that is, the deep 
chest, is a primitive or infantile type. 



128 The Law of Growth. 

It may also be well to note that in girth and breadth 
of neck we have illustrated what will be found true in 
studying the measurements of mature people, namely, 
that a large neck is usually found under a large head, 
and vice versa — the neck developing as a support to the 
superimposed mass. 

In strength we see the arm developed more rapidly 
than the legs — this again pointing to the rudimentary 
type, as demonstrated by Louis Robinson. 

In studying the second line (boys 12-13 years) in rela- 
tion to the first and the central straight line, we may 
note an acceleration in the development of lengths as 
compared with the first line and a retardation in other 
records as compared with the straight line. The strength 
tests show symmetrical but comparatively small increase, 
except in forearm. The girth and breadth of head show 
a slight advance, but comparatively the least increase of 
all the measurements. If, now, we study the fourth. (14-15 
years) line upon the chart and compare it with our central 
line, we see that it diverges more widely at all points 
than does the second line, while the fifth line (15- 
16 years) bears much the same relation to the fourth 
that the second bears to the first. The lengths have 
now outstripped the girths and breadths, while the 
girth of head and waist show a comparative retardation, 
which indicates an approximation to their completed 
growth. What is true of the head seems to be also true 
of the strength tests of the arm, while the strength tests 
of legs and trunk show marked acceleration, until they 
slightly outstrip the standard that might be expected 
from the girths. The depths show a retardation, like 
the head, and we see our boy evolving from the round 
primitive type into the broad form of the erect animal. 

Let us now glance at these lines, bearing in mind the 
ages that they represent, for here they show in most 



The Law of Growth. 129 

unmistakable manner the law of growth, as first demon- 
strated in this country by Dr. Bowditch in his classic 
paper. The period of the fourteenth year is a period of 
retarded growth, and is immediately followed in the fif- 
teenth year by a period of greatly accelerated growth, 
this being the period of pre-pubertal acceleration, while 
the retardation is seen to be fully as marked as the accel- 
eration and corresponds in its mathematical value closely 
to it. In other words, if we were to draw a line midway 
between the second and the fourth line it would repre- 
sent on either side a year of what may be considered 
average growth, according to the standard set by the 
space between the first and second lines and by that 
between the fourth and fifth. In other words, the accel- 
eration of the fifteenth year is sufficient to at least make 
up for the retardation of the fourteenth. 

The question has often been raised as to the value of 
the percentile method in grouping small numbers of 
measurements, and much doubt has been expressed as 
to its value by prominent anthropometrists. The pre- 
sentation of this table is an unanswerable argument in 
favor of the position taken by the author and others, 
that a small number of measurements is sufficient, when 
the group considered is complete, to produce a percen- 
tile chart that shall represent definitely the type of the 
group considered and that shall not vary more from the 
true type of the group than the probable error of the 
examiner, and consequently for practical graphic use 
will be as serviceable as a chart prepared from large 
numbers of measurements, especially where these meas- 
urements are collected by different individuals and from 
different groups, being subject to the personal equation 
of the examiner and the variations of the local types. 

The growth of the male and female child correspond 
very closely until the eleventh year in both weight and 



i3° 



The Law of Growth. 



height. The boy is heavier at birth by one-fourth kilo- 
gram and taller by a centimeter. During the first week 
of life there is a loss in weight but after that epoch of 
adjustment to a new source of nutrition is passed the 
increment of weight is fairly steady until the eleventh 
year when the girl begins to grow more rapidly in both 
weight and height and outstrips the boy, remaining both 
heavier and taller until the fourteenth year, when the 
boy again becomes taller than the girl and in his next 
year he surpasses her in weight. This is shown graphic- 
ally in Fig. 54, where the line AA represents the height 





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Fig. 54 



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19 20 21 22 25 2" 24 



& 



The Law of Growth. 



■31 



of boys and BB the height of girls; the line CC repre- 
sents the weight of boys and DD the weight of girls. 
The line EE shows the percentage of growth in height 
for the various years and emphasizes the periods of 
retardation and acceleration more than the lines repre- 
senting the actual increment. 




132 



The Law of Growth. 



An interesting and valuable physiological fact is dem- 
onstrated in the growth of lung capacity as shown in 
Fig. 55,* this varying with weight and finally distribut- 
ing the curves so as to represent essentially 
the proportions demonstrated by Kellogg as 
actually occurring in strength tests, and by 
Foster, Atwater, and others, as theoretically 
possible from the metabolism represented 
by the waste eliminated. 

The variations in nerve ability are found to 
bear a close relation to the periods of abrupt 
variations in the curve of growth. 
This is shown in Fig. 56f where 
the dotted line represents the vol- 
untary motor ability of boys, the 
broken line that of girls and the 
solid line both boys and girls. 




A 



* Studies from the Yale Psychological Laboratory, Vol. II. 
f Gilbert. Researches on the mental and physical development of 
school children. 



CHAPTER IX. 

EXAMINATION BY INSPECTION. 

After the measurements of a person have been taken, 
the work of examination and physical diagnosis should 
begin. The measurement is mechanical and could be 
done correctly by any person after a little practice, but a 
physical examination requires the highest product of 
scientific training backed by sound judgment in order to 
discover the true condition of organs and determine the 
real cause of the disordered function or disturbed 
growth. It may require only a mechanical eye to dis- 
cover a curved spine, but it must be the mechanical eye, 
backed by a thorough knowledge of physiology and 
anatomy, that can discern the fact and the cause. 

Inspection should be made with the subject entirely 
nude and standing easily. If a military attitude is 
assumed, try to get relaxation into the ordinary posi- 
tions. This can often be done by calling the attention to 
some trivial matter, as any peculiarity of the hands or 
feet, or by having the subject step forward or backward 
a few steps when he will forget his strained position. 
From the front notice (i) the general coutour or relative 
breadth, (2) the position of the head, (3) the position of 
the shoulders and arms, (4) the curves of the trunk and 
linea alba, (5) the muscular condition of chest, abdomen 
an,d legs, (6) any malformation, such as asymmetry, 
tumors, cicatrices, etc. 

From the side notice (7) the antero-posterior or normal 
spinal curves, (8) the depth and mobility of the chest 
and abdomen, (9) the position of the shoulders, (10) the 
relation of the hips to the loins, or the pelvic tip, (11) the 



134 Examination by Inspection. 

relation of the neck to the trunk, (12) the general atti- 
tude of the subject, or the poise. 

From the rear notice (13) any lateral or spiral curva- 
ture of the spine and prominence of spinous processes, 
(14) the condition of the shoulders and scapulae, (15) the 
waist curves, (16) any tipping of the iliac crests due to 
one leg being shorter than the other or imperfect bone de- 
velopment, (17) the outline and position of the legs, as 
in knock -knees, bow legs, etc., (18) the muscular condi- 
tion, (19) the condition of the skin, and (20) any tumor 
or malformation, varicose veins and cyanosis. 

Of course the examiner will not look up each one of 
these points in regular order, but he should study each 
one and after an examination go over this list and see 
how many points there are on which he has no clear, 
definite knowledge, and then try on the next case to 
make the list smaller until he will take in everything at 
a glance, as it were. There are many other matters to 
which attention might be called, but they are mostly 
amplifications of the above list. 

We include in (1) the breadth of head as giving some 
idea of the temperament and vitality of the subject. A 
broad head at the base is believed to indicate a greater 
vitality than is found when the head is long and "top- 
heavy. ' ' There is greater power of resisting disease and 
less liability to nervous irritability of a pathological char- 
acter. A thin, weak neck means a bad curve forward at 
the cervical portion of the spine, and a consequent flat 
chest in a large majority of the cases. The voice will be 
uncertain and the throat suffer from catarrhal diseases 
on the slightest provocation. The circulation of the 
head will be poor and congestive headaches common. 

Narrow shoulders mean compression of the upper part 
of the thorax, and less activity of respiration in the 
apices of the lungs. This, with a history of tuberculosis 



Examination by Inspection. 135 

is unfortunate, because tubercular degeneration usually 
begins at the apex of the lungs and an inactive part is an 
unhealthy part. This fact has led Dr. T. J. Mays to 
claim in an article published in the "Therapeutic 
Gazette," May, 1887,* that the wearing of corsets by 
ladies may be a protection against phthisis, because by 
compressing the abdomen and lower part of the thorax 
costal breathing with a freer use of the apices of the lungs 
was necessitated and a consequent immunity from tuber- 
cular degeneration was the result. The fallacy of this 
theory has been repeatedly shown but by no one so com- 
pletely demonstrated as by Dr. J. H. Kellogg, whose 
investigations regarding normal respiration are complete 
and original, f 

The breadth of chest is one of the three factors in 
making up the ' ' Vital Capacity, ' ' and its relation to the 
breadth of waist and hips will give a better idea of the 
natural strength than the size of the biceps. Any depres- 
sion of the ribs or sternum should be noted. I have 
seen a case of severe hepatic disturbance that had re- 
sisted medical treatment for many months recover more 
than ordinary health under a series of excerises that 
tended to lift two depressed ribs over the liver into a 
more arched and natural position. 

Notice any elevation of the chest wall in the cardiac 
region, and any transverse depression at about the sixth 
rib. The elevation may be due to enlargement of the 
heart or pericardiac effusion. The depression is due to 
faulty habits of sitting — the person sliding forward in his 
chair and sitting on the sacrum, instead of on the but- 
tocks. This depression causes a pressure on the heart 
and interferes with the circulation and also causes indi- 
gestion quicker than plum pudding by restraining the 

* See "Med. News," Nov. 27, 1886. 

f Transactions of the Mich. State Med. Society, 1888. 



136 Examination by Inspection. 

muscular activity of the stomach which is very marked 
during digestion. This "creased chest" is a postural 
deformity. 

Under (2) we should note any position of the head that 
might denote a shortness of the sternomastoid muscles. 
A shortness on one side tends to tip the head toward that 
side and turn the face to the other ; if both muscles are 
short they tend to draw the neck forward and tip the face 
up. This is a frequent condition and if well marked 
gives a very awkward poise, especially if in (7) we find 
the cervical curve very deep, or the neck slanting for- 
ward because of poor support from weak muscles. A 
strong neck is very desirable. It not only holds import- 
ant organs in place and insures good circulation in the 
brain by making the channels direct but it gives an 
aggressive carriage, and indicates determination and 
pluck. In (3) we observe the slope of the shoulders and 
the relation of the acromions to the sternum. If a line 
be drawn from the tip of the acromion to the base of the 
neck and continued to the spine, it will make an angle 
with the line of the spine which should approximate to 
8o°. If the muscles that support the shoulder be weak, 
they permit the acromial tips to sink-, making the angle 
less, while if these muscles be over-developed they draw 
the tips up and give a stiff, hunched appearance that is 
ungraceful. If the muscles in front be better developed 
than those behind, the shoulder will be drawn forward 
and down, giving an apparently flat chest with sloping 
shoulders, which is a mark of slack habits and lack of all 
exercise of a natural character. This form is sometimes 
seen among gymnasts who devote themselves to one 
kind of exercise, as horizontal bar practice, etc. The 
effect of this posture on respiration will be evident to 
every person with a knowledge of the elements of anat- 
omy. The person has no energy or "sand" because his 



Examination by Inspection. 137 

blood is not properly aerated. The arms hang forward, 
giving the feeble, helpless attitude assigned by caricatur- 
ists to the innocent "dude." 

By (4) we mean the outline curves of the waist which 
show something of the strength of trunk that may be ex- 
pected, and the outlines of muscles that give the beauti- 
ful curves seen on the athlete. These lines may not be 
clearly cut in some cases of well developed muscles on 
account of the adipose tissue immediately under the skin, 
but in every healthy person they give character to the 
anterior wall which otherwise becomes as expressionless 
as a bag of meal. This last point will help us in estimat- 
ing muscular condition (5) which cannot be judged alto- 
gether by size. 

It is well to remember that, in (6), we must not only 
decide as to the character of the malformation but know 
what the prognosis or probable development will be — 
what interference with exercise will be caused and what 
exercises are contra-indicated — what will be the influ- 
ence on health — what does it indicate as to the physical 
stamina or constitutional strength. For instance, vari- 
cose veins may never have given any trouble and may 
never have been noticed. How long could this condition 
exist unnoticed and what may be expected from it now ? 

What exercises should be avoided, etc., etc.? 

In surgery the word tumor means any abnormal en- 
largement of an organ or tissue. Perhaps the most fre- 
quent form of tumor that will be found is due to rupture 
or hernia. A hernia is a tumor caused by the passage of 
a portion of an organ through the bony, muscular or ten- 
donous wall that normally confines it. It may be pro- 
duced suddenly by a severe strain or bruise, or it may be 
the result of a gradual distension of one of the natural 
openings of the wall. Cases of intestinal hernia are fre- 
quently found, and among young men will affect two or 



j 38 Examination by Inspection. 

three per cent of all, while among those past middle life 
it will affect as high as six per cent. Among females it 
is much less frequent. This is due to the less patulous 
inguinal openings in the female and to less exposure in 
the daily avocations of life. Abdominal hernias are 
classed as inguinal, femoral, umbilical, diaphragmatic, 
etc., according to the place where the viscus forces its 
way through its natural support. The small intestine or 
the omentum is the tissue that usually protrudes. 

An inguinal hernia may appear at the external inguinal 
ring as a round tumor of greater or less extent and is then 
called "direct, " while if it appears first at the internal 
ring and passes down the canal it is called "oblique. " 
The latter form is much more frequent and tends to 
develop rapidly downward, giving the tumor an elon- 
gated form with higher origin than the direct. 

In femoral or crural hernia the intestine passes down 
through the crural ring under Pouparts' ligament where 
it causes a protrusion of the anterior wall of the thigh in 
a round tumor that lies in the groin just below the fold 
at the saphenous opening. It is situated farther exter- 
nally from the median line than the direct inguinal and 
if large will have its axis in a horizontal rather than a 
perpendicular direction. A hernial tumor gives a 
marked impact to the finger of the examiner if firm 
pressure is made while the subject coughs. 

These three forms of tumor must be readily differen- 
tiated from cystic tumors, varices, glandular enlarge- 
ments, etc. 

Cysts have a well-marked fluctuation. Varices have 
fixed relations to the venous trunks and subside on the 
•subject assuming a horizontal position and fill again on 
rising even if the inguinal rings are supported. Gland- 
ular swellings are due to some attendant local irritation 
and are painful and unyielding to pressure. Each case 



Examination by Inspection. 139 

of hernia should be referred to the family physician or to 
a surgeon for advice and treatment. No gymnastic 
instructor should take the responsibility of prescribing 
•exercise for such cases without advice. The same may 
be said of all tumors. 

The antero-posterior curves of the spine (7) are a con- 
cavity in the cervical and lumbar regions and a convex- 
ity in the dorsal and pelvic. These curves may all be 
•exaggerated by disease or occupation or muscular devel- 
opment. Any increase in the curves must shorten the 
total height. Any weakness of muscles at the back of 
the neck will permit the head to hang forward, thus 
increasing the dorsal convexity, producing round should- 
ers, or kyphosis. An over-development of the lumbar 
muscles as compared with those of the abdomen will 
increase the lumbar concavity, causing lordosis. The 
strong back is the straight back. 

The gymnastic treatment of lordosis, or abnormal ante- 
rior curvature, is the only satisfactory one where there is 
no caries or breaking down of bone. The same is true of 
kyphosis, of which Dr. Stedman writes:* "A cure of ado- 
lescent kyphosis, when of slight degree, may be obtained 
oy exercise alone, without mechanical support, but it will 
be found advantageous to aid the patient in maintain- 
ing an erect posture by suitable apparatus. The treat- 
ment by exercises in this form of kyphosis should never 
be omitted, since the fault lies chiefly in a want of tonic- 
ity of the muscular and ligamentous tissues." 

If there is exaggerated curve at any part of the spine, 
there will be more or less compensatory curve in the 
opposite direction at other parts ; and, in prescribing exer- 
cise, great care must be used in deciding which is the 
primary and which the compensatory curve, for an error 

* Wood's Medical Reference Handbook. See, also, Lagrange's 
*'La Medication par 1' Exercise." 



140 Examination by Inspection. 

would make matters worse from the development of parts 
already strong, and the neglect of parts that are weak. 

In observing the depth of chest and abdomen (8) and 
the movement of each under respiration we have a clue 
to the activity of the person. If the chest is deep at the 
sixth rib, but thin at the second, the sternum will usually 
be found unsupported by the muscles of the neck ; those 
behind being weak and letting the spine slope forward 
at the upper part so that the sterno-mastoid and the sca- 
le ni muscles can not raise the chest. This throws all the 
work of respiration on the diaphragm, and the person is 
unfitted for any athletic exercise, and would have a 
cramp in his side if he were to run an eighth of a mile. 
It is said that a round chest of equal girth with a flat one 
will not show as great a lung capacity on the spirometer 
and my experience corroborates the statement if the- 
extreme types are taken. 

If the abdomen protrudes or sags so that the intestines 
seem to be held just above the pubic arch, especially if 
there be a history of hernia, or excessive corpulence, or 
indigestion, the matter is of such import as to call for 
thorough instruction and earnest advice. Much discom- 
fort, ill health and physical suffering will be saved such 
cases, if the abdominal muscles be developed by persis- 
tent exercise — the abdominal cavity contains quite as- 
important organs of health as the thorax, and the com- 
petent instructor will not spend all his time and efforts in 
developing the chest. 

In (9) (10) (11) (12) we have some of the points that go 
to make up the carriage or general appearance of the sub- 
ject, and they constitute the difference in physique 
between a West Point cadet and a slouching loafer. 

Our rear view of the subject will disclose any lateral 
curvatures (13) of the spine, or scoliosis, and we should 
not only see any deformity of this character but should 



jl. ■..:".:'■.:.-.■. . ;h I-::r{:::: r . : \ I 

l>e able to judge of its nature, and determine its causa- 
tion. The curve may be simple and confined to one part 
of the spine, or it may be multiple. In the latter case 
one of the curves is usually the primary lesion, and the 
^others compensatory. The reason for the compensatory 

r is ::azt :z the zataral e±":rt :: rzairtaiz az ere;: 
carriage I: ::r:r :e a slight aarvatare :: the lef: in the 

tezf :: : the si: : alaers : 

aaiahtez the seize has 
-most success where the muscle is stronger, and not at the 
point of greatest weakness, toward which the convexity 
lies. The result is the bending of the upper part into 
sa;h a z :siti:z that the "eir'at :s iz e= ailihriarz. aza ::.: 
shc-alders fair". 7 level 7h-is e±':rt :: zeza a higher r:r- 

. : alazce :: vre: 5 
the taase ::' 1 slighter azrve higher •:;: iz :':.: :ervi:=l 
r:rti:z. :ha: res::res ::.z heaf :: the rre:: a:sa:l:z 
7 has a ::re :: :':.r lei: :r_ lazatar repair zaaa ;azse 
another higher up to the right, in dorsal region, and 
azither still higher :: the left 1a :he :ervi:al a irttzz :f 
the spine. If this explanation is correct it is plain that 
the zrerlisr siza :azse ::' s;:l::sis raas: he iae :a a larae 
majority of the cases, to the weakness or uneven devel- 
<cczaez: :f :ze :zzs:les -t: lzrazzez:s that saaairt the 
-spine. If the muscular strength and activity of one side 
re greatly ia e:::ess ::' that :: the ther :ae srzze raas: 
of necessity be drawn to that side which will throw the 

exity toward the weaker side. If this principle 
obtains in all the anatomical relations — and its influence 
cannot be denied — no better argument could be used in 
favor of training for bilateral symmetry. In connection 
with s::li;sis :r lateral :urvarare :: :he striae ::ra :s 
nearly always a twist of the spinal column on its long 

the other is pushed forward 7 his deformity is called 



142 Examination by Inspection. 

rotation and its importance is quite as great as the amount 
of lateral displacement. The rotation is seen more 
readily when the subject bends forward —one side then 
appearing higher than the other. 

The fact that girls are arrected by spinal curvature more 
often than boys (the proportion being four to one) would 
seem to indicate a need of more robust exercise out of 
doors or in gymnasiums that shall give such a develop- 
ment of the erector spinae mass, and all the muscles above 
the hips, as shall compare favorably with that of boys. 
The influence of corsets and stays has been repeatedly 
shown to be the cause of great muscular debility in the 
parts constricted, and all medical authorities assign a 
large part of responsibility for curvatures to their use. 
The lumbar muscles of the female have a comparatively 
larger field of origin at the pelvis and should be corres- 
pondingly strong, but under the differentiation of civili- 
zation and the corset, the female waist has degenerated 
into a bachache. 

Pressure on a muscle tends to drive the blood out, and 
if it be continuous, the circulation is impaired. This 
condition means bad nutrition of the muscle, and that 
leads to imperfect development or to actual atrophy. Is 
it any wonder then that a physician hears from his 
female clients one long complaint of weak backs, back- 
aches and general debility! 

The remedial exercises for curvatures need only be 
suggested here, as the only treatment, is forcible straight- 
ening and proper exercises. The care should be exer- 
cised on the weakest spot, which, in some way, "must 
stand the strain." Suspension, as on the rings and bars, 
and the direct exercise, either active or passive, of the 
degenerate muscle, is the general plan of treatment. 

The prominence of the spinous processes are of diag- 
nostic value in locating weak spots. If the interspinous 



Examination by Inspection. 143 

ligaments have been strained and stretched by lack of 
muscular support or bad habits of posture, as sitting back 
on the hips, and letting the weight of the trunk press the 
lumbar vertebrae back, or a pernicious habit of letting 
the head hang forward, the saw-toothed appearance of 
the spine, as the subject bends well over, will disclose 
the fact. Notice the alignment of these processes as the 
subject is bent over and straightens up. A failure of 
one or two, here and there, to stand in the line, is not an 
indication of disease, but is due to a slight bend in the 
process, as will be seen on examinating almost any skele- 
ton. The spinal curvature will be indicated by a number 
of them assuming a general curved outline. 

The mobility of the scapulae (14) varies greatly in dif- 
ferent people. A more beautiful contour exists when the 
trapezius and rhomboidei are strong and short, holding 
the scapulae down and well back to the spine, but the 
range of arm movement is not so great. A good devel- 
opment of these muscles is very desirable as they prevent 
the shoulders from rolling forward and flattening the 
chest. 

In (15) notice the size of the lumbar muscles, with the 
subject bent over. 

It should be borne in mind that a shortness of one (16) 
leg is comparatively frequent and this deficiency causes 
the pelvis to tip with resulting spinal curvature. Dis- 
tocia, or deformity of the pelvis may have the same effect. 
It is well to notice the comparative height of the dimples 
that mark the posterior superior spinous processes of the 
ilii, as they indicate to some extent the position of the 
base on which is erected the bony column of the spine. 
This base should be perfectly horizontal. 

The bone of the legs (17) cannot be greatly changed 
by exercise, but something can be done in early life to 
relieve one of the burden of bow legs or knock knees. 



144 Examination by Inspection. 

Therefore, in the examination of children do not overlook 
this point, nor needlessly turn the attention of the sub- 
ject to it when there is no relief, but occupy his mind 
with matters that can be improved and modified. In 
observing the legs notice any cyanosis about the ankles, 
and varicose condition of the veins, especially of the 
lower leg. In some persons the skin is firm and seems 
to fit the underlying tissues very closely, thus giving sup- 
port to the venous walls, while in other cases the skin is 
relaxed and thin, furnishing poor support to the super- 
ficial vessels. If we recall the fact that the hydrostatic 
pressure alone in a person of ordinary height, while 
standing, would be trifle over one kg. in the vessels 
of the foot, and that the friction of the current along the 
vessel wall, the impediment from constriction of clothing 
and speed of the current, all add to this pressure we can 
readily see why certain classes of people are specially 
liable to dilation of the veins, and suffer accordingly. 
Persons obliged to stand much of the time without 
great change of position (as clerks, book-keepers, bench 
mechanics, etc.), and very fat people, who stand a con- 
siderable part of the time, are most often affected. The 
pressure on the external iliac vein in corpulent people is 
a predisposing cause, as it prevents the free return of 
the blood into the trunk, and the same may be said of 
garters, tight clothing on the thighs, or elastic thigh 
bands, tight belts around the waist, corsets, and any gar- 
ment or device that prevents normal respiration (see illus- 
trations, Chap. XIII.). The proper advice in these cases 
is clear. Restriction should be placed on all exercises 
like jumping, where the feet strike the ground hard; run- 
ning on pavement, floors, etc., bicycle riding, because of 
the pressure of the saddle falls on the femoral and saphe- 
nous veins; violent exercises, like foot-ball, etc., etc. 
Light exercise should be encouraged, for, the better the 



Examination by Inspection. 145 

tone of the tissues, the less giving way will there be to 
pressure. Exercise of the skin to keep it healthy and 
firm — such as massage and cold water baths, to stimulate 
the contraction of the tissues — will be of assistance. In 
this condition "forewarned is forearmed " Cyanosis is 
a varicose condition of capillary veins and indicates poor 
circulation. In cyanosis about the trunk search carefully 
for some heart lesion. 

The condition of the skin (19) will signify much to the 
careful examiner. Not that every subject with acne 
should be set down as dyspeptic, but in an almost intui- 
tive way the careful observer will learn to diagnose many 
internal ailments and judge of vices that might other- 
wise be unknown. There is something that cannot be 
described in the healthy, firm, velvety skin of an athlete. 
It must not only be seen, but felt, in order to be appre- 
ciated. It is better to be rolled in the dust by a hearty, 
healthy wrestler than to shake the flabby, moist hand 
that is placed in yours by some advocate of moral suasion 
and intellectual top-heaviness. The skin, like the eye, 
is the mirror of the bodily health, if we only know how 
to see the image clearly. Its firmness, its elasticity, its 
smoothness, its moisture, its odor, its color, its warmth, all 
are full of meaning. Physicians often read the complaint 
in the countenance of the patient, before his mouth has 
uttered it. We have in observation not only the facial 
countenance but the expression of the whole body. How 
much, then, should we rightly judge of the inner man! 
The delicate tint seen on the skin of the woman who has 
exercised in the open air, until every tissue proclaims her 
the type of health, is as superior to the rusty covering of 
the dyspeptic house plant as that is superior to the hide 
of a pachyderm. Local diseases may deform the skin, 
but the indications of general health will be found, if it 
exists. 



146 



Examination by Inspection. 



The following table will present in compact form some 
of the more prominent points observed by inspection : 

GENERAL ASPECT. 

f Flat. 
I Round. 
Aspect of chest. \ Bilateral asymmetry. 
I Sternum depressed. 
(_ Pectoral muscles. 



(1) Form. 



Front View, 



waist. 



legs. 



j Breadth. 
\ Muscles. 

Bow-legs. 

Knock-knees. 

Muscles. 



Side View. 



Rear View. -< 



<« n P rV < Sterno-mastoid. 
necK ' \ Lateral muscles, 
f Poise of head. 
j " " thorax. 

" " loins and belly. 
(_ " " hips. 

fNeck. 
f B , fl ,,1 Shoulders. 

I Hips. 
Height of acromions. 
Line of spinous processes. 
Scapulae. 
Pelvic crests. 



f Unduly thin, j g^/ 8 ^ \ Atrophy. 



(2) Nutrition. 



fat. 



Eruptions. 



Cicatrices. 



i Evenly distributed and firm. 
■] Unevenly " and soft. 

( Fatty degeneration. 

r Acne, furuncles, etc. 
Eczema. 
Psoriasis. 

( Circinatus. 
Tinea, -j Versicolor. 

( Tricophytosis. 
Ulcerations. 
Erysipelas. 

f Bruises. 

Burns. 

Cuts. 

Lacerations. 
Carbuncles, variola, etc. 

Abscesses 



Traumatisms. 



j Free. 
I Bone. 



Examination by Inspection. 



I4T 







' 


( Comedones. 


(3) The Skin. - 




Sebaceous. -j Seborrhoea. 




( Sebaceous cysts. 






C Ichthyosis. 






Hypertrophy. -1 Goiter. 






( Condylomata, callus, etc. 




Tumors. -< 


( Chicken breast. 
Malformation. < Retained testis. 

( Funnel chest, etc 










f Varicocele. 






Cvsts i H y drocele - 
^ysts. < Hernia> 

[ Abscess. 










r Lentigo. 






Chloasma. 






Jaundice. 




Discoloration s. - 


Erythema. 

Purpura. 

Cyanosis. 








Bruises. 



CHAPTER X. 

EXAMINATION BY PALPATION. 

The use of the sense of touch, or palpation, is of great 
importance in locating tumors and determining chest 
movements, viz : frequency of respiration, vocal fremitus, 
ronchi, frictions, etc. By the eye you can only imper- 
fectly judge of size and consistency. An arm may be 
large, but, if soft and flabby, it does not indicate health 
or strength ; while if it meets our hand with a proper 
resistance — not too hard nor too soft — we know that it is 
capable of good things, be it large or small. Palpation 
enables us to say how much fatty tissue underlies the 
skin, and how firm the muscle is under the fat. It is a 
mistake to set every person with abundant adipose tis- 
sue in the list of "muscles undeveloped." Nor is fat a 
substance of no worth to the physical economy and to be 
avoided. In certain quantities it is of the greatest advan- 
tage to health, and is an indication of high nutrition. It 
is so much physiological capital stored up, and is so 
located as to prevent loss of heat by radiation, especially 
over the more sensitive organs, and therefore saves the 
energy that would be lost in heat. This is nature's way 
of protecting her children from the increased severities 
of the season, for, as autumn brings presages of winter by 
her cooler nights, every animal, in health, grows fat, and 
those that are exposed to continued low temperatures, 
like whales, seals, bears, etc., lay up enormous stores of 
it underneath the skin, where it will do the most good, 
and over the abdominal organs and heart. If the supply 
,of food is cut off, the fat is consumed to provide vital 
force for long periods of time. The same is true of man, 



Exami7iation by Palpation. 149 

but to a less extent. As civilization has relieved him of 
many of the exigencies of nature, it has modified his 
requirements, restricting them in some directions, and 
enlarging them in others. The modern civilized man 
needs less fat than the Esquimaux, because he has a 
milder climate and better facilities for heating his house, 
but he needs some fat to prevent the irritation of the 
nervous tissues during the adjustments of heat produc- 
tion that are so rapid in a well-balanced body, when we 
pass from a cold to a warm atmosphere and the reverse. 
This strain is thrown on the involuntary or sympathetic 
nervous system, and this is the part that breaks down in 
the so-called "nervous exhaustion" or "neurasthenia," 
which is so common. Not that lack of fat stands in caus- 
ative relation to this disease, but that one source of strain 
is found here. Such persons bear the cold badly and 
seek warmth, their treatment is warmth and nutrition. 
The argument, then, is that a fair amount of fat is con- 
ducive to health of the nervous system. The same may 
be said of all the other organs. The lean man has no 
extra physiological resource to fall back upon, if irreg- 
ularities are forced upon him, either in the way of les- 
sened food supply, or sleep, or greater demand on his 
energy, either physical or mental, and his comfort and 
health soon suffer. 

By palpation we may also judge of the temperature 
and moisture of the skin, and thus estimate its activity in 
excretion. A healthy skin should be firm and velvety, 
even in texture and activity, slightly moist under ordi- 
nary circumstances but not wet, colored a delicate shade 
of pink, without being flushed or having dilated capillary 
vessels, as will be found common in the clavicular or 
scapular region. If the skin is hot and flushed, it indi- 
cates the presence of fever, or a local disturbance of cir- 
culation, due to deranged nerve activity. If the skin be 



150 Examination by Palpation. 

dry, and tends to form scales, the superficial circulation is 
insufficient, and bad digestion is a common accompa- 
niment. Free exercise, shower bathing, massage and 
friction will set things to rights if persistently employed, 
unless the skin be affected by ichthyosis, which "is a 
congenital, chronic, hypertrophic disease," and hence 
will be but little benefited. Profuse perspiration is 
found frequently, and seems injurious only in prolong- 
ing bronchial inflammations and general catarrhal con- 
ditions, by keeping the clothing damp a large part of the 
time. There is also an increased liability to Bright 's 
disease from high concentration of urine and chilling of 
the surface on slight exposure. 

Hyperidrosis will be favorably influenced by active 
exercise, as the circulatory system will at that time be 
depleted by the free sweating, and will give up less mois- 
ture in a state of rest. After exercise the damp clothes 
removed, the sweat washed off in the shower bath, and 
the skin dried by proper massage, leave slight liability 
to "colds. " Local hyperidrosis may seriously impair the 
health by keeping the feet damp and cold and thus induce 
catarrhal, pneumonic, and rheumatic conditions. Medi- 
cal advice is to be recommended in such cases, if hygi- 
enic precautions — such as cold baths, frequent change of 
clothing, sensible shoes with cloth tops, proper diet and 
regular exercise — do not avail. At times the under and 
inner surfaces of the toes and the outside margin of the 
foot from the little toe back to the instep will appear 
white and swollen in these cases. This condition closely 
resembles large blisters from scalds, but is only a water- 
soaked, "parboiled," state of the epidermal layer, like 
that seen on the hands of washer- women after they have 
been in hot soap-suds for a half hour. The advantage of 
a cloth-top shoe in these cases is apparent when we think 
of the comparative ease with which moisture passes 



Examination by Palpation. 151 

through woolen fabrics as compared with difficulty of 
evaporation through leather. 

A condition of anidrosis, or too scanty perspiration is 
frequent without evident impairment of health. The skin 
is apt to get very dry and harsh, especially in cold weather, 
and eczema of the hands result. In many of these cases 
there is no general sweating, even in extremely hot 
weather, and perspiration is not copious. 

It may be well to explain that "perspiration" is the 
term applied to the insensible exudation from the sweat 
glands that is evaporated as fast as secreted, while 
*' sweating" is the appreciable collection of this exuda- 
tion in drops of greater or less abundance. (See Foster's 
Physiology.) 

In addition to what we learn of the integument and 
muscle by palpation, we detect by it certain movements 
that characterize health or disease. If we place the hands 
firmly on the walls of the chest, letting the fingers press 
the intercostal regions, there will be felt a movement of 
the chest on each inspiration and expiration, if respiration 
be normal. Any failure in expansion is noticed if there 
be interference with the chest action, from muscular or 
mechanical cause, that is unilateral. There should be 
bilateral symmetry of movement, but this may be hin- 
dered by muscular soreness from rheumatism, neuralgia, 
traumatism, etc. ; paresis of a muscle, or group of mus- 
cles ; intrapleural effusions ; new growths ; or by solidifi- 
cation of the lung or any considerable part of it. Malfor- 
mations may also interfere with bilateral symmetry of 
movement. 

If the subject be asked to repeat some word such as 
"ninety-nine," or to count aloud, one, two, three, while 
the hands are on the chest, as above described, a peculiar 
vibration will be felt, which is known as the "vocal frem- 
itus." This thrill, or vibration, is much more prominent 



152 Examination by Palpation. 

in persons with thin chest walls and low pitched voices, 
than where the wall is thickly padded with fat, and the 
voice in high key, on the same principle that the low bass 
strings of a piano, when struck, impart vibration to solid 
articles in the room in an appreciable degree, while the 
high notes have a less perceptible effect. The "vocal 
fremitus" is somewhat plainer on the right side, on 
account of the larger size of the right bronchial tube. 
A fremitus may be caused by other sources of vibration 
than the voice, as by a cough, by mucous rales, by pleu- 
ritic friction, and the splashing of liquid, when the chest 
contains liquid and air. 

The "ronchial fremitus," due to mucous in the bron- 
chial tubes, is frequently very marked in bronchitis, and 
felt by the subject himself; but the area is circumscribed 
in most cases. The friction fremitus of pleuritic inflam- 
mation is faint and local in character. In general, those 
diseases that produce solidification of the air cells of the 
lungs, without obstruction of the bronchial tubes, 
increase the vocal fremitus; while those that interpose 
more air, like emphysema, decrease it. Liquids diminish 
or check it altogether. The scapulae interfere with the 
fremitus, as does the liver, the latter not conveying the 
vibrations, and, if pressing firmly against it, preventing 
the chest wall from doing so below the margin of the lung. 

Palpation is of great service in the diagnosis of tumors. 
The fingers are to be placed on one side of the swell- 
ing, and gentle but firm pressure made on the opposite 
side of it with the fingers of the other hand, by a quick 
movement of the wrist. If the contents of the tumor are 
liquid a bulging will be felt under the fingers, caused 
by the displacement of the fluid, that passes as a wave 
through the tumor, distending the sac at one part to 
accommodate the liquid depressed at another. This 
peculiar wavelike motion, called fluctuation, can be well 



Examination by Palpation. 153 

studied by examination of a rubber water bag tinder 
varied thickness of covering, having the bag distended 
hard, and again with less water in it, but no air. In 
cases of ascites the wave impulse is readily felt across the 
abdominal cavity — a light tap with the end of the finger 
against the side being sufficient to start the wave. A 
close estimate of the amount of fluid can be formed in 
this wa3% as the wave simply continues through the liquid 
part, and is not propagated by the intestines or general 
tissues. 

The apex beat of the heart may also be located by pal- 
pation in a large majority of cases. In many subjects 
the chest wall is thin, and the heart action strong, so 
that inspection can determine the apex impulse with tol- 
erable precision; but if it fail to fall in an intercostal 
space, or the chest wall be thick, or the heart-beat feeble, 
palpation must be used. In this connection it may be 
said, that for this purpose the ear may be the organ of 
tactile, as well as of auditory impressions. 

The character of acute or chronic inflammatory 
action can often be determined by palpation, as in swell- 
ings about joints. Tumors and impactions in the 
abdominal cavity can be diagnosed by this process and 
their general character determined. 



CHAPTER XL 



EXAMINATION BY ASCULTATION AND PERCUSSION. 



The condition of the internal organs is determined in 
■several ways. Among- the most frequently employed, 
because most satisfactory in results, is by listening to 
the passive and active sounds so far as the3^ can be 
secured to the ear. The passive sounds are obtained 
by percussion, or striking the surface over an organ, 
either with the tips of the fingers or a rubber mallet 
directly, or by laying a solid surface, or the finger, firmly 
against the surface, and striking this. The first method 
is called immediate percussion, and is seldom used, except 
for hard, bony surfaces. The second is called mediate 
percussion, and is applicable to all parts. 

The sounds obtained by percussion vary in quality, 
intensity and pitch. The quality of the sound obtained 
over the various organs can only be rudely described, 
but practice will give skill in distinguishing it. The 
intensity will vary according to the surrounding 
medium, and the pitch will vary largely through 
change in the organs that produce the sound. 

The region of the body most frequently examined by 
percussion is the thorax. The abdomen, especially in 
conditions of disease, is often examined by this method 
(in connection with palpation), but without the satis- 
factory accuracy that is to be secured over the chest, 
although it enables one to distinguish the outline of solid 
tumors of hepatic, splenic or intestinal origin and the 
area covered by cystic enlargements. 

The method of employing percussion is generally with 
the fingers, although, if many examinations are made 



Examination by Auscultation and Percussion. 155 

-daily, it is well to use a pleximeter and percussor (see 
Figs. 19, 20). It seems to the writer that the appre- 
ciation of vibrations by the finger is of considerable 
importance in assisting the ear, and, therefore, that 
digital percussion is better than instrumental. The act 
is easily performed by laying the fingers of one hand 
firmly over the part to be examined, and, with the tips of 
the first two or three fingers of the other hand, or the 
middle finger alone, striking against one of the fingers 
imposed on the part with a firm blow, accomplished by 
a wrist movement of flection. The force of the blow 
may be varied to perceive the difference in resonance, 
quality, and pitch of the sound under the new conditions, 
as this may have an important bearing on our determi- 
nation of the case. Forcible percussion sets in vibration 
deeper tissues, and, if their condition varies greatly from 
the superficial tissues, there will be a mixed quality to 
the sound that aids in identifying healthy activity, or 
disease, or abnormal position. For instance, if we begin 
at the right clavicle and percuss downward, until we 
reach the lower edge of the liver, we shall pass over lung 
tissue at first where the sound elicited under mild or 
forcible percussion is essentially the same ; lower down 
we reach a part of the lung that contains the large bron- 
chial tubes when the pitch is lower and resonance good, 
then still lower to a part that is backed by the upper con- 
vexity of the liver with only the solid diaphragm and 
lung between it and the chest wall. Here under mild 
percussion the resonance is unimpaired; but under a 
firmer stroke the resonance is found to lose its clearness 
and become duller, and this dullness increases as we per- 
cuss to the very edge of the lung, where the sound is flat 
(see Fig. 57). The term "flat," as applied to percus- 
sion sounds, is such a quality of tone as is produced 
-when an organ containing no free gaseous element is set 



i56 



Examination by Auscultation and Percussion. 



in vibration by an impact. The word "dullness" is com- 
parative only and denotes less resonance than should be 
expected under normal conditions. 

In using the pleximeter, we press it firmly against the 
surface, and strike upon it with the rubber percussor. 




Fig. 57. 

Showing the normal outlines and positions of the heart, lungs, 
liver, and stomach. The light dotted line shows the outline of the 
lung at inspiration, b d, at expiration.///, and also the lobar divis- 
ions at i k I. The heavy continuous line shows ihe outline of the 
liver. The light line shows the loca'i'm and divisions of the heart. 
The heavy broken line indicates the outline of the stomach. Luschka. 

The resonance of the instrument is slightly confusing to 
the person who has been accustomed only to digital per- 
cussion, but practice soon enables us to eliminate this 
sound, as one does the sounds of mercantile life while 
listening to a voice in the telephone. Practice alone will 



Examination by Auscultation and Percussion. 157 

give skill in the determination of normal or abnormal 
sounds. It may be remembered that for any individual 
the resonance of the chest is fairly constant in health, but 
that of the abdomen varies continually; again, the reso- 
nance of the abdomen is always tympanitic or flat, .while 
that of the healthy chest is neither. In making a physi- 
cal examination, percussion of the abdomen is useless, 
unless there be a history of abdominal disorder, or inspec- 
tion and palpation indicate something abnormal. 

For convenience in describing any location on the ante- 
rior aspect of the trunk there has been a long-continued 
custom of dividing the body into a right and left half by 
a median perpendicular line and then designating the 
portion on either side above the clavicle as the supraclav- 
icular region, right or left. The portion below the clav- 
icle as far down as the third rib is called the infraclavic- 
ular region and the part covered by the clavicle is called 
the subclavian region. The mammary region extends 
from the third rib to the sixth. Below the sixth rib is 
the inframammary region, extending to the margins of 
the ribs. The lower sternal region extends from the 
ensiform cartilage to the third costal cartilage, and from 
this point to the sternal notch is called the upper sternal 
region. From the top of the stermine to the cricoid car- 
tilage is the suprasternal region. The limits on the 
right and left are perpendicular lines drawn from the 
tips of the acromions. At the side the axillary region 
extends from the summit of the axilla to the sixth rib, 
and below this is the infra-axillary space, extending to 
the bottom of the chest. 

The abdomen is divided into nine regions for purposes 
of description, as follows (Fig. 58): Draw a horizontal 
line across at the level of the narrowest part of the waist 
and a second line at the level of the iliac crests. Draw a 
perpendicular line from the middle of Poupart's liga- 



'58 



Examination by Auscultation and Percussion. 



ment, on each side, extending up to the chest. On the 
outside of these lines will be found, above, the right 
and left hypochondriac regions extending down to the 
first horizontal line. Between the horizontal lines will 
be the lumbar regions and below these the iliac regions 
bounded by Poupart's ligament. The central portion is 
called the umbilical region. Above this is the epigastric 
and below the hypogastric regions. 

In examining a subject by percussion it is well to begin 
on the supra-clavicular region and percuss lightly and 

then forcibly on each 
side, and press the fin- 
gers well against the in- 
tercostal muscle rather 
than over the ribs, while 
proceeding to the lower 
edge of the chest; then 
percuss the right axil- 
lary region; then the 
posterior thoracic, from 
top to bottom, strik- 
ing on alternate sides 
in order to discover 
any difference in sound 
that may exist, and 
There should be equal 
each side behind, unless 




Fig. 58. 
the left axillary space 



then 

resonance of sound on 
there be extreme unevenness of muscular development, 
which will slightly dull the sound on the strong side ; but 
in front the location of the heart to the left of the ster- 
num, and the liver to the right of it, and lower down 
gives a wide variation in sound for similar locations on 
the two sides. On the right we usually find the point of 
liver dullness beginning about 2 cm. below the nipple, 
while the line of flatness is about 6 cm. below it — the flat 



Examination by Auscultation and Percussion. 



59 



area extending about the breadth of the hand, or to the 
edge of the ribs, and around to the spine (see Fig. 59). 
On the left the area of heart dullness begins at about the 
third intercostal space, near the sternum, and extends 
out to a point nearly an inch above the nipple, and down 




Fig. 59. 
Showing the areas of percussion dullness and flatness over heait, 
liver and stomach, i k line of beginning dullness around the heart. 
a d b c area of flat sound or without pulmonary resonance, p q 
line of dull area over the liver, e c ?n I area of flatness over liver. 
m n area of varying resonance over the stomach. Weil. 

for 3 cm., shading off into the flat heart area — that is cir- 
cular above about 5 cm. in diameter and having its center 
at a point half way between the nipple and the center of 
the end of the sternum, and reaching downward to the 
sixth rib, where it is merged in the stomachic resonance 
(see Fig. 57.) 



160 Examination by Auscultation and Percussion. 

The line of stomach dullness is of variable location and 
may not be perceptible at all. 

The percussion sound of the abdomen is tympanitic or 
flat, according to the existence of gas in the intestinal 
canal. In case of ascites, a peculiar wave impulse is 
started by immediate percussion that is readily felt by 
the other hand held against the abdominal wall opposite 
the point of impact. The same is true of cystic tumors 
in other locations, where the walls are protected only by 
soft tissues, as in effusion into the synovial cavity of the 
knee and other joints, as a result of inflammation or hem- 
orrhage. This wave impulse corresponds to the fluctua- 
tion of palpation. (See page 152.) 

The area of liver dullness should not extend below the 
lower edge of the ribs, on the right side, while the spleen 
is found well around to the left side, extending from the 
line of dullness at ninth rib, downward about eight cm., 
the breadth being about half this distance (Fig. 59). 
In ordinary cases the spleen is not to be sought, as its 
function is not fully known, and its recognized abnor- 
malities are confined to malarial and congestive fevers, 
with occasional malignant growths. The length of the 
thorax will be found to vary greatly in different people, 
and, where the ribs come well toward the umbilicus, the 
liver should hardly reach to the lower edge of the ribs, 
except in front, while in the cases of short chest it may 
extend five or more cm. below the free margin. The 
left lobe extends across the median line for about six 
or eight cm. (Fig. 59), where its limits are not readily 
discovered by percussion, on account of the area of heart 
dullness. At the right side the liver extends down to the 
tenth intercostal space, and behind it reaches to the last 
rib (Fig. 60). 

It should be remembered that the lower limits of the 
liver may very greatly without its being an indication of 



Examination by Auscultation and Percussion. 



161 



enlargement or disease. In examining this organ, there- 
fore, it is well, if any apparent malformation exists, to 
determine by percussion, and mark with a flesh pencil the 
outline of the organ. The exact measurements can then 




Showing the positions of the kidneys, j k, and spleen, h ; margin 
-of liver, /. The dotted line, e f g, shows the lobar divisions of the 
lungs. Scheube. 

be made and malposition differentiated from hypertro- 
phy. 

Some of the more common causes of malposition are 
tight lacing, pleuritic effusion, congenital and traumatic 
malformations, pericarditis with effusion, and certain 
abdominal tumors. For convenience in treating the nor- 



1 62 Examination by Auscultation and Percussion. 

mat positions of certain organs, the following points 
should be fixed in mind : 

The sternal notch is on a level with the top of the 
second dorsal vertebra or tip of seventh cervical spine. 

The spine of the scapula is on a level with the third 
dorsal spine. 

The lower angle of the scapula is on a level with the 
seventh dorsal spine. 

The base of the heart lies at the fourth dorsal spine. 

The apex of the heart lies at the level of the eighth 
dorsal spine. 

The apex of the lung lies opposite the seventh cervical 
spine and vertebra, and from two to four cm. above the 
top of the sternum. 

The base of the lung is on the level of the tenth dorsal 
spine. 

The spleen lies on the level of the ninth and eleventh 
dorsal spines. 

The upper convexity of the liver lies on a level with 
the eighth dorsal spine or slightly above the lower end 
of the sternum. 

The nipple usually covers the fourth intercostal space 
at level of sixth spinous process. 

These locations are all referred to the spinous pro- 
cesses of the vertebra as fixed points that can always be 
found. If we rub the ball of the thumb firmly down the 
furrow between the erector spinae muscles, the tips of the 
spinous processes will show as pink spots on the skin. 
This method is recommended by Dr. Holden to deter- 
mine the existence of lateral curvatures. 

In auscultation we have the method of most precise 
knowledge in diagnosis. By other methods of examina- 
tion we may learn that there is something wrong, but 
the ear is the supreme court to decide the case and tell 
what that "something" is. For purposes of auscultation 



Examination by Auscultation and Percussion. 163 

several instruments have been devised, but none better 
for general use than the binaural stethoscope of Dr. 
Camman, Fig-. 17, .with its improvements for clasping 
into the ears, without undue pressure. The unassisted 
ear is able to do all that is required in most cases, as the 
sounds are equally distinct, but the ear cannot be readily 
applied to all parts of the chest, and to attempt it in some 
cases would be to affect other parts of the sensorium with 
more profound salutations. 

The stethoscope also enables us to localize sounds 
closely by making a direct course of travel for sound- 
waves. Consequently, it readily transmits those waves 
that pass directly into its bell or tube, while those waves 
that are not thrown directly in, are either lost or become 
obscure, so that our attention is centered on the sounds 
produced directly beneath. The pressure of the aural 
tips closes the external meatus of the ear, so that foreign 
sounds are entirely eliminated. 

The following points in the use of the instrument 
should be borne in mind : 

1. Apply the instrument to the ears so that the aural 
tips will point downward and inward, thus following the 
direction of the meatus of the ears. 

2. Have just sufficient pressure in the ears to hold the 
instrument steady and make the tips fit perfectly. 

3. Let no foreign material touch against the stetho- 
scope at any part of it during use, as friction-vibrations 
will be set up. 

4. Press the bell firmly over the spot to be auscultated, 
so that it fits the integument perfectly all around. If the 
surface is uneven the soft rubber bell should be used. 

5. Do not let the fingers move on the instrument while 
holding it in place. 

6. Always apply directly to the skin, as nothing satis- 
factory can be heard through even a thin layer of cloth. 



164 Examination by Auscultation and Percussion. 

7. The examiner should keep his own head as nearly- 
erect as possible to avoid cerebral congestion from 
venous constriction. 

Where the naked ear is used a soft cloth can be inter- 
posed between it and the subject. 

In listening to the sounds of the mitral and tricuspid 
valves with a stethoscope, it is well, should there be 
doubt in diagnosis, to place a thin cloth, like a napkin, 
on the chest, and auscultate through it. The only sound 
heard through this will be the valvular click — the first 
sound becoming short and uncomplicated like the second 
sound. 

In auscultation continued practice must be given to 
learning normal sounds and their relations. If the 
examiner knows every healthy sound with its variations, 
he will instantly recognize an abnormal one, even if he is 
not able to clearly state or even understand the existing 
lesion. Some sounds are so complicated as to defy expe- 
rienced surgeons in reading their significance. 

The following points are to be studied: 

(a) Muscle-sounds, by placing the stethoscope over a 
muscle like the biceps, during its' contraction and relax- 
ation. 

(I?) Heart-sounds, by studying the sound at each loca- 
tion in the precordial region and along the large arteries. 

(c) Lung-sounds, in every region of the chest. 

(d) Intestinal-sounds, that are caused by the gases of 
fermentation. 

(e) Succession or splashing sounds of fluid in the 
stomach (or chest), while it contains free gas. 

(/.) The "bruit" or hum heard in many cases over the 
large venous trunks, especially of the neck and upper 
chest and over aneurismal sacs. 

A muscle sound is of low pitch and vibratory quality— 
a. rapid throbbing as it were. Its character is repre- 



Examination by Auscultation and Percussion. 165 

sented in exaggerated form by moistening the end of the 
thumb and then rubbing it along the surface of a wooden 
table with a fairly rapid movement. The thumb will 
jump along the surface giving a low vibration to the 
wood. This muscle sound is the cause of the peculiar, 
prolonged "booming" sound of the heart during its con- 
traction, and it modifies the valve sound of closing to 
some extent; therefore the directions on page 28 should 
be followed if there is an apparent systolic murmur. 

The valve sounds are brief in duration, of high pitch 
and clicking or non-resonant quality. These sounds are 
confused more or less by the muscle sound, by respira- 
tion sounds and by the vibrations of blood currents both 
normal and abnormal. These abnormal sounds are 
generally of blowing quality and are called murmurs. 
They will be studied more at length in Chapter XII. 
The sounds of the normal heart must be patiently studied 
with the stethoscope until its every peculiarity is familiar; 
its rhythm, its force, its various valve sounds, its points 
of clearest differentiation of complex sounds and its trans- 
mission of sounds, the relation of the pulse in various 
localities to heart impact, etc. It is only by a thorough 
acquaintance with normal conditions that the abnormal 
can be recognized. 

There will be found frequent cases of arterial and 
venous murmurs or humming sounds that will be likely 
to be mistaken for heart murmurs. These have a loca- 
tion over the larger blood vessels and the sound is con- 
tinuous rather than intermittent, if of venous origin, and 
if arterial, the sound is usually not heard at the heart, 
but at some point where a large trunk makes a sharp 
turn or is narrowed by pressure of adjacent structures, as 
in the subclavian artery. The venous murmur may vary 
from a low hum to a whistling sound. The jugular vein 
is the spot where the venous hum is most frequently 



1 66 Examination by Auscultation and Percussion. 

heard, and in many cases a hum can be produced by an 
uneven pressure of the stethoscope, making a slight con- 
striction in the calibre of the vessel. Turning the face 
of the subject to one side will sometimes produce a hum 
on the opposite side. This sound has been called by 
some writers an anaemic hum, but its cause can hardly 
be assigned directly to the quality or quantity of the 
blood. Anaemia might be a factor in the production of 
the sound by causing a softening of the tissues support- 
ing the vessel, and the watery venous blood may be 
sonorous to a larger extent than arterial blood, as taught 
by Walshe, but the direct cause must be the unevenness 
of the calibre of vessels, through which blood must be 
flowing at a speed bearing some relation to the size of 
their lumena. 

Arterial murmurs may be due to roughness of the 
inner coat due to inflammations or vegetations, saccula- 
tions, or pressures. These causes would produce systolic 
murmurs that would be loudest over the site where they 
are produced. From similar causes murmurs may be 
produced in the cavity of the heart itself. Another class 
of murmurs is found in extremely nervous people, exces- 
sive tobacco users and over-trained athletes. It is due 
to irregular muscular action of the heart, with conse- 
quent imperfect closing of the valves, and is therefore 
systolic and heard more commonly over the base of the 
heart. These murmurs are not constant, and do not fre- 
quently, if ever, exist with benign hypertrophy. 

Heart murmurs due to dilatation of the cavities from 
anaemia do occur, and in those cases it is difficult to 
decide whether there is aortic obstruction or a simple 
dynamic murmur. In the first case, however, we would 
find a powerful heart impulse from hypertrophy, while in 
the second there would be a feeble impulse from the imper- 
fect contractions. At times the respiratory sounds may 



Examination by Auscultation and Percussion. 167 

confuse the heart sounds by the air being driven out of 
a portion of the lung by the heart impulse, giving rise to 
a sound that may be mistaken for a heart murmur. This 
sound would be systolic and not heard at the apex. 

It is well, then, in examination, to apply the stetho- 
scope to the apex of the heart first and then over the 
base, listening carefully to the valvular sounds and ask- 
ing the subject to suspend respiration in expiration for a 
moment if any abnormal sound is heard. Then listen 
over the carotid and subclavian arteries on each side. If a 
humming sound is heard that cannot be understood, let 
the subject take some of the gentler strength tests, and 
after a slight acceleration of the pulse listen again, and so 
proceed until he understands the case. The case may 
not be one to be determined in a few minutes or days. 



CHAPTER XII. 

THE SIGNIFICANCE OF CERTAIN PHYSICAL SIGNS. 

In listening to the sounds of the lungs we must also 
have a fixed idea of the normal before endeavoring to 
study abnormal sounds. In perfect health the normal 
vesicular murmur of the lungs varies within quite wide 
limits of force, pitch, quality and duration, due to the 
difference in thickness of the chest wall and the activity 
of respiration in different individuals, but the general 
character of the sounds remains the same. 

This sound has been likened to the faint rustling of dry 
leaves or straw, but the only description that is of help 
to a student is the one that he makes to himself by con- 
tinuous use of the stethoscope and naked ear applied to 
the chest. 

The following points may be borne in mind as helpful 
in examination: 

i st. The murmur is shorter in expiration than 
inspiration, and in some cases the murmur is entirely 
suspended during expiration. 

2d. The murmur is harsher over the region of the lar- 
ger bronchial tubes, becoming milder as we pass down- 
ward to the base. 

3d. The heart sounds will tend to confuse the lung 
sounds in the front of the left lung, but only in a few 
cases is it difficult to hear only the sounds you search for. 

4th. The sounds of bronchial breathing are heard in 
simple, uncomplicated form, over the trachea and upper 
sternal region. 

5th. The quality of bronchial respiration sound is 
tubular and harsh ; the pitch is high. 



The Sigyiificatice of Certain Physical Signs 169 

6th. The expiration sound is longer than inspiration 
in the region of pure bronchial breathing. 

7th. Vesicular or fine respiratory murmur is heard to 
the lower margin of the lung tissue. 

8th. If the murmur ends abruptly at any point above the 
natural border of the lung, and the murmur is normal, 
suspect an effusion into the chest cavity. 

9th. Normal flatness may begin as high as the sixth 
rib on the right side, and at the seventh on the left. 

The abnormal respiratory sounds are called rales. 
They are in general of the bronchial type rather than the 
vesicular. The sounds may be dry and rasping as when 
the tubes are contracted by an inflammation at the initial 
stage or a spasm of the muscular fibres of their walls or 
by local pressure. The sounds are called moist when 
the tubes are obstructed by more or less fluid. These 
rales may be so loud as to obscure the vesicular murmur. 

The crepitant rale is a fine dry, crackling sound, heard 
in the last part of inspiration in pneumonia and phthisis, 
and has been compared to "the sound produced by rub- 
bing a small wisp of hair between the thumb and finger 
near the ear," "pulling postage stamps apart," etc. 

The subcrepitant rale is heard in bronchitis, pneu- 
monia, oedema of the lungs, phthisis, etc. It is a fine, 
moist, bubbling sound, heard in both inspiration and 
expiration. 

Coarse bronchial rales are heard in bronchitis, phthisis, 
etc. , and are caused by mucous interrupting the flow of 
air. These rales may be so loud as to be heard without 
applying the ear to the chest and if the mucous is very 
dry a whistling sound will be produced. 

Gurgling rales are sometimes heard, especially if the 
subject is very weak and cannot expel thin mucous from 
the larger tubes or if there is a cavity in the lung from 
tubercular degeneration. 



170 The Significance of Certain Physical Signs. 

Aside from the respiratory sounds the vocal resonance 
is of importance in determining the condition of the 
lungs. 

1 . The laryngeal voice is heard over the trachea and large 
bronchial passages, while in the general area of the chest 
the sound is modified and softened, until the vocal 
expression is lost except over the right bronchus, and, in 
thin persons, the left. 

2. This tone with "far-away" quality is known as the 
pulmonary resonance. It corresponds to the vocal fre- 
mitus of palpation. 

3. Increased resonance indicates some consolidation of 
the lung without closure of the bronchial tubes, cavi- 
ties, pleuritic adhesions or compressed lung tissues from 
effusions. 

4. Diminished resonance is due to obstruction of the 
bronchi or a layer of fluid between the lung and chest 
wall. 

5. Suppressed resonance is caused by large effusions in 
the pleural sac, with compression of the lung or new 
growths. 

6. Broncophony or a development of the bronchial 
type of resonance in unusual locations indicates a con- 
densation or hardening of lung tissue or cavities. 

7. Amphoric resonance indicates very large cavities or 
pneumohydrothorax. The quality of the sound is 
musical and metallic ; the pitch and the resonance hollow 
and without articulation. 

8. Whispered resonance is found in as many forms as 
vocal resonance, and its modifications are due to the 
same causes. It is a more delicate test of slight consoli- 
dation and hence should be thoroughly studied. In nor- 
mal cases it presents a soft blowing sound at the upper 
part of the chest only, where consolidation usually begins. 

9. A cough resonance is helpful at times in securing 



The Significance of Certain Physical Signs. 171 

cumulative evidence of a condition suspected from other 
sources of information. This is specially true of the 
diagnosis of cavities. 

In considering the sounds of the heart it is well to bear 
in mind the anatomical features of the heart, and the 
course of the blood as it passes into the heart and through 
it to the aorta. The blood from the lower parts of the 
body is conducted by the inferior vena cava to a point 
near the heart where it meets the current brought from 
the upper parts by the superior vena cava, and unites 
with it to form the innominate vein which empties into 
the right auricle after a length of 30 to 40 mm. There is 
no valve at the mouth of this vein, but blood can flow 
backward through it under pressure. The right auricle 
is a pouch-like sac with only a small amount of muscu- 
lar fibre in its wall. This auricle acts as a reservoir of a 
fairly steady current whose contents are discharged at 
intervals into the ventricle or muscular compartment 
directly below it. This act of discharge is easy during 
the period of diastole or relaxation of the ventricular 
muscle, and is accomplished by gravity and the contrac- 
tion of the auricular walls. When the ventricle is dis- 
tended with blood the muscular walls begin to contract, 
and the blood is forced toward the two openings, the 
pulmonary artery and the auriculo-ventricular passage, 
but this latter is fringed by the tricuspid valve which is 
quickly closed by the current and the blood sent on to 
the lungs. At the opening of the ventricle into the pul- 
monary artery there is a valve composed of three semi- 
lunar flaps of pocket shape, which prevents a return cur- 
rent after the contraction or systole has ceased. 

After passing through the pulmonary tissue the blood 
comes back to the left side of the heart and enters the 
left auricle by the pulmonary veins which are unguarded 



172 The Significance of Certain Physical Signs. 

by valves to prevent a regurgitation. The right auricle 
is very similar to the left in function and anatomical 
character. From it the blood passes down into the left 
ventricle during its period of diastole, and is prevented 
from flowing back during the powerful contraction of the 
ventricle by the mitral or bicuspid valve. This closure 
of the auricular orifice leaves only the opening of the 
aorta by which the blood must be driven out, and which 
then conducts it to the general circulation. At the aortic 
opening are located semilunar valves to retain the blood 
that has once passed into the arterial trunk, so that it 
cannot flow back and refill the ventricle during its 
period of receptivity. 

It is clear, then, that in normal heart action we must 
have four valvular sounds, and these must all originate 
at points at no great distance from each other. In fact 
a circle of 25 mm. radius drawn from a center at the ster- 
nal end of the fourth costal cartilage on the left will 
cover the four valves. There are points, however, where 
each sound is heard more plainly, and these are for the 
mitral valve at the apex of heart ; for the aortic valves at 
second intercostal space just at the right of the sternum, 
and over the right common carotid artery; for the tri- 
cuspid valve at middle of the sternum at the level of the 
nipple ; for the pulmonary valve at the left of the ster- 
num in the second intercostal space. The mitral and 
tricuspid sounds must be at the beginning of the systole, 
and are called the first sound of the heart, while the 
semilunar closings will be at the end of the systole, and 
are called the second sound of the heart. The first two 
sounds are synchronous and also the last two. 

The first sounds are prolonged by the muscle vibra- 
tion into a full booming sound, while the second sounds 
are short and clicking. Foster illustrates the difference 
by pronouncing the words loob-diib in the same relative 



The Significance of Certain Physical Signs. 



173 



time at the heart sounds. Between the second and first 
sounds is an interval that is essentially two-fifths of the 
time required for a complete cycle of heart action. This 
is called the period of rest. 

The following table is a summary of normal heart 
sounds : 



NORMAL HEART-SOUNDS. 



Sounds. 
1. Muscular. 



2. Mitral 



valve. 



3. Aortic 

valve. 



Tricuspid 
valve. 



5. Pulmonary- 
valve. 



Location. 

Within boundary limits of 

heart or precordial area. 

Behind the 3rd left intercostal 
space and 4th costal car- 
tilage about 20 mm. from 
sternum. 

Behind the left edge of the 
sternum at the level of the 
3rd intercostal space. 



Behind the sternum at the 
level of the 4th costal car- 
tilages. 

Behind the junction of the 
3rd costal cartilage with the 
sternum on the left. About 
in front of the aortic valve. 



Where Heard. 
Heard best at apex and 
just above. 

Just above apex beat 
and at 3rd intercostal 
space on left of ster- 
num. 

At 2nd intercostal space 
on right of sternum, 
and over the common 
carotid arteries. 

At lower end of the 
sternum above the 
ensiform cartilage. 

At 2nd intercostal space 
to left of the sternum. 



The boundary limits of the heart as given by Holden 
are as follows : 

For the base draw a horizontal line over the third cos- 
tal cartilages extending 12 mm. to the right and 25 mm. to 
the left of the sternum. For the apex draw a perpendic- 
ular line 50 mm. long downward from the left nipple and 
from its lower extremity draw a horizontal line 25 mm. to 
the right, which will bring the pencil over the apex to 
the heart in the fifth intercostal space. The nipple is 
usually located over the fourth intercostal space. From 
the apex draw a curve to the end of the sternum, and 
continue it up more sharply to the right edge of the 
sternum, and continue it upward to the right end of the 



174 The Significance of Certain Physical Signs. 

base line by a gentle curve. The left side will be marked 
by a curve of about 200 mm. radius extending from the 
left end of the base line to the apex (see Fig. 57). 

The part of the heart not covered by lung tissue is 
inconsiderable, and is described by Dr. Latham as being 
outlined roughly by a circle of 25 mm. radius drawn from 
a center half way between the nipple and lower end of 
the sternum (see Fig. 59). 

Abnormal heart sounds are usually called murmurs, 
and result from four causes: 

1. The failure of valves to perfectly hold the blood 
from leaking through. 

2. The narrowness of the opening through which the 
blood is forced into a tube of larger caliber. 

3. Friction of the external surface of the heart against 
an inflamed pericardium. 

4. Friction on endocardium from vegetations. 

The first cause may be due to active inflammation of 
the valves from endocarditis, etc., that produces vegeta- 
tions or uneven thickening of the valves and therefore 
imperfect closure, or the walls of the heart may become 
so distended as to prevent perfect coaptation of the 
valves. Other causes also may produce imperfect closure. 

The second cause usually depends on inflammation 
that has caused a deposit of fibrous tissue around the 
orifice affected. 

The third cause is more often the result of an injury 
or strain, and is found in some cases after violent exercise. 

The fourth is found after fevers, rheumatism, etc. 

The character of these abnormal endocardial sounds is 
hissing or blowing, and for this reason they are called 
by some writers ''bellows murmurs," while the friction 
sound is more squeaking or grazing in its quality, and 
can frequently be diagnosed by the fremitus discovered 
by palpation. 



The Significance of Certain Physical Signs. 175 

The pitch varies in all the sounds from a low, gentle 
murmur to a high whistling note — the pitch giving us 
some idea as to the size of the opening ; for if the sound 
be caused by a stream forced through a small aperture 
the pitch will be higher — the surfaces set in vibration 
being much shorter than in the large opening. 

The most common heart lesion is a failure of the 
mitral valve to perfectly close the left auriculo-ventric- 
ular passage. This is called mitral insufficiency. It 
is plain that any fault in the closing of this valve would 
permit the blood to flow back into the left auricle during 
systole, and that this would cause increased pressure in 
the auricle and pulmonary veins, thus interfering with 
respiration and distending the auricle. As the heart 
contraction forces blood into the aortic arch, there is an 
effort toward straightening the aorta from the pressure, 
and this brings the apex of the heart against the chest 
wall at about the fifth intercostal space. This brings a 
continuous vibratory medium of solid tissue from the 
point of vibration to the external surface where we may 
receive it by the ear or stethoscope. We also find that the 
sound is carried to the left axillary region along the fifth 
or sixth rib. The sound is heard over the valvular region 
at the base of the heart but without characteristic quali- 
ties. The time of the murmur is during the systole, and 
hence it begins with the valvular click of the first sound 
and ends with the second valve closing at the aorta which 
gives the second sound. 

If the heart sounds are so deranged that it is difficult 
to decide which is the first sound, it may be determined 
by remembering that it is synchronous with the impact 
of the apex against the chest wall, and also with the 
pulse wave in the carotid arteries. The following sphyg- 
mogram shows the typical disturbance of arterial pressure 
in mitral regurgitation (see Fig. 61). 



■i 7 6 



The Significance of Certain Physical Signs. 



The curve is not abrupt in the sys- 
tole, and the pressure is not sus_ 
tained to the dicrotic wave. If the 
systole is very energetic the pulse 
would be large but soft. The 
rhythm is irregular. Fig. 62 shows 
mitral regurgitation 
with slight aortic in- 
sufficiency. In order 
to understand the 
meaning of these Fig. 61. 



Fig. 62. 




D 

Fig. 63. 



curves, let us study briefly the normal pulse tracing(Fig. 63). 

^ "All scientific investigators agree that 

the line A represents the cardiac contrac- 
tion, the impulse being conveyed to the 
needle through the arteries in the same 
manner that the impulse is given to the 
last marble in a row of marbles by striking the first 
marble in the row a quick blow, the difference being 
that the row of marbles does not advance, while the 
blood current does. This ascent we will call the systolic 
wave. 

"The arteries thus suddenly filled begin immediately by 
virtue of their elasticity to contract and the needle 
descends to the point B. Next we have a wave, the 
cause of which is not definitely settled. It is generally 
believed that the wave B-C, called the tidal wave, is due 
to a rebound of the blood from the terminal vessels or 
capillaries, for the following reasons: 

"The tidal wave is more perceptible nearer the capil 
laries. 

"The base of tidal wave approaches the systolic line and 
systolic apex the farther the tracing is taken from the 
heart. 



The Significance of Certain Physical Signs. 177 

"Sweating renders the tidal wave less perceptible and 
the base nearer the dicrotic notch. 

"From C the artery again contracts till the needle 
reaches point D. The rise at D is generally conceded to 
be due to the rebound of blood from the closed aortic valves 
and is usually termed the dicrotic wave. The remainder 
of the cycle represents the diastole or rest of the heart."* 

rv Fig. 64 shows a normal pulse » 

J ^v J V of high tension and Fig. 65 a /I /I 
Fig. 64. normal pulse of low tension. v Fig. 65. 

The lesion that stands second in frequency is obstruc- 
tion at the aortic orifice — any narrowing of this opening 
that makes its caliber less than that of the aorta will pro 
duce a murmur and tend to increase the work of the ven- 
tricle with resulting hypertrophy. It obviously does not 
menace life and health to the same extent as mitral 
insufficiency. The sound being produced by the current 
forced out by the contraction of the ventricle it must be 
synchronous with the systole and end with the second 
sound of the heart. Its location being at the base of the 
heart, we would expect to find the sound clearest at the 
beginning of the aorta. It is in fact heard most dis- 
tinctly over the sternum at level of the second rib or just 
to the right of the sternum, and is also heard over all the 
large arterial trunks of the upper thorax and neck. It 
is called aortic stenosis. 

rs\ Fig. 66 illustrates the typical pulse 

\J ^\^/ V^, tracing in this lesion. The systolic curve 

Fig. 66. i s no t abrupt nor high, but the pressure 

is well sustained past the dicrotic notch. The pulse is 

small and usually regular. 

The third lesion in frequency is a regurgitation of 
"blood through the semilunar valves from the aorta into 

*See an article on "Use of the Sphygmograph," by Dr. J. G 
Smith, in An. Rep. of the Amer. Assoc, for Adv. of Phys. Ed, 1888. 



178 The Significance of Certain Physical Signs. 

the left ventricle. Evidently this can only occur dur- 
ing the diastole of the heart. It should be heard in the 
same locations as the murmur of aortic stenosis, and 
also down along the sternum. The lesion is termed 
aortic insufficiency. 

The interference with the pulse is shown by 
Fig. 67. Its characteristics are marked. The 
r l\ )v\ systolic curve is high and abrupt. The fall is 

Fig. 67. abrupt. The dicrotic wave is small. The 
pulse is quick and strong — the "bullet" pulse. 

The fourth lesion producing a characteristic sound is 
mitral obstruction due to stenosis of the left auriculo- 
ventricular passage. This would interfere with the 
passage of blood from the auricle to the ventricle in the 
period of diastole. The murmur being started during 
the stage of auricular contraction and ending with the 
beginning of the first sound ; it is called presystolic. It 
is heard over the mitral valve and at. the apex of the 
heart, but is not transmitted over a large area. This 
lesion leads to much pulmonary disturbance on account 
of the increased blood pressure in the lungs. 

The fifth lesion is obstruction of the pulmonary orifice 
from stenosis. This would place extra work on the right 
ventricle, which hypertrophies by natural accommoda- 
tion. The murmur must be systolic and heard over the 
second cartilage to left of the sternum. It is prolonged 
upward and to left of the sternum for only a short dis- 
tance as the artery soon divides into small branches to 
ramify through the lungs. 

The sixth lesion is a regurgitation through the tricuspid 
valves due to insufficiency of the closure. It is systolic 
and causes great increase of venous pressure by the 
current forced back into the auricle and through it into the 
venous trunks causing a venous pulse. It is heard at junc- 
tion of ensif orm cartilage with the sternum and to the apex. 



The Significance of Certain Physical Sounds. 



179 



The seventh lesion is an obstruction of the right auric- 
iilo-ventricular opening by narrowing, and hence the 
murmur must be presystolic. 

It is heard over the middle of the sternum at level of 
fourth cartilage, and is not transmitted except to a slight 
extent downward to the end of sternum. It is called 
tricuspid stenosis. 

The eighth lesion is a regurgitation through the valves 
(semilunar) at the opening of the pulmonary artery, and 
is termed pulmonary insufficiency. It tends to enlarge- 
ment of the right ventricle, and interferes with the pul- 
monary circulation and aeration of blood. In time it 
must be diastolic, and is heard at the region of the 
second left costal cartilage. The sound is carried along 
the sternum faintly. 

A murmur is transmitted, in general, by the blood and 
hence in the direction of the current. 



Condition. 

1. Mitral regurg. 

2. Aortic obstruct. 

3. " regurg. 

4. Mitral obstruct. 

5. Pulmon. obstruct. 

6. Tricusp. regurg. 

7. " obstruct. 

8. Pulmon. regurg. 



TABLE OF ABNORMAL HEART SOUNDS. 

Transmitted. 



Heart Sound. 
ist. sound. 



After 2d sound. 



tst sound. 



After 2d sound. 
With 2d sound. 



Heart Action. 
Systolic. 



Diastolic. 



Systolic. 



Diastolic. 



Where Heard. 

Mitral area and 
apex. 

2d. rt. cost, car- 
til, at sternum. 



2d. rt. cost, car- 
til, at sternum, 

Mitral area and 
apex. 

2d. left cost, car- 
tilage. 

Just above ensi- 
form cart. 

Sternum at head 
of 4th rib. 

2d left costal car- 
tilage. 



Along 6th rib to 
axilla. 

To top of ster- 
num and ar- 
terial trunks. 

Down along ster- 
num. 

Not transmitted. 



Up a short dist., 
ends abruptly. 

Down a short 
distance. 

Not transmitted. 



Up a short dis- 
tance. 



Lesion: 
Mitral insuf.. 



Aortic 

stenosis-. 



Aortic 
insufficiency. 

Mitral 

stenosis. 

Pulmonary 
stenosis. 

Tricuspid 
insufficiency. 

Tricusp. 

stenosis. 

Pulmonary 
insufficiency- 



180 The Significance of Certain Physical Sounds. 

If these lesions be tabulated in the order of their fre- 
quency it will be observed at once that the left side of 
the heart is most frequently affected — all possible abnor- 
malities having representation before the most frequent 
murmur of the right side. The reason for this is clear 
when we consider the vastly greater extent of tissues to 
be supplied by the left side of the heart compared with 
the pulmonary circulation supplied by the right. 

The exocardial murmur is due to the movement of the 
heart rubbing two inflamed and roughened surfaces 
together. The pitch is usually high and quality squeak- 
ing. It has no connection with the valve sounds in time 
or location — is not transmitted in any particular direction 
and if loud, may be felt as a fremitus at the apex beat. 
It has no influence on the pulse curve. 

The Pulse of Mitral regurgitation : 

(a) Compensated, is soft and often large. 

(b) Uncompensated, is soft and short (celer.). 

" «' " " stenosis is small and soft (sometimes frequent 

and often irregular). 
" " " Aortic regurgitation is quick, large, "shotty pulse" 

(and regular). 
" " " " stenosis is small and long (tardus). 
" " " Tricuspid regurgitation is venous. 

There is a normal venous pulse. In time it precedes 
the arterial pulse, and may be said to alternate with it. 
It is caused by the auricular systole and the consequent 
stopping of the free current toward the heart. 

The abnormal venous pulse is discovered most easily at 
the lower part of the jugular vein, and is synchronous 
with the arterial pulse, being due to the same cause, 
namely, the systole of the ventricles. This indirect cur- 
rent can be forced into the veins only when there is 
insufficiency of the tricuspid valve. 






CHAPTER XIII. 



PRESCRIPTION OF EXERCISE. 






The main object of a physical examination is to learn 
as many facts concerning the physical needs and tenden- 
cies of the subject as possible in order to be able to 
advise him properly regarding his exercise and personal 
hygiene. Without being able to give exactly the meas- 
ures of a perfect man or woman we must have a standard 
of form and development that is derived from a knowl- 
edge of anatomy and experience in observing the indi- 
viduals that present the highest evidence of perfect 
health and power. We learn also in a negative way by 
a study of pathological cases. The persons of impaired 
health can usually be so classified in groups with com- 
mon symptoms that certain physical signs will be found 
common to nearly all in the group. Then by a study of 
the history of these cases we can judge with some cor- 
rectness whether the physical sign stands in the relation 
of cause or effect to the abnormal symptoms. For 
instance, if we group together all cases of organic lung 
diseases such as tuberculosis, chronic bronchitis, recur- 
rent attacks of pneumonia, pulmonary congestion, 
emphysema, etc., and find that a very large per cent of 
the cases have in common poorly developed respiratory 
muscles, flat chests, sagging shoulders, etc., with no 
other common feature, we may properly conclude that a 
chest of this type is not favorable for the healthy activ- 
ity of lung tissue and in no sense is it a model toward 
which we should endeavor to conform the flexible chests 
of our people. 

But our inference might be very far from truth and 
untrustworthy if we did hot also approach the subject 



1 82 Prescription of Exercise. 

from a different line of study and reach the opinion in 
a positive way. We do this by grouping the individuals 
that have proved their ability for enduring prolonged 
mental and physical strain, the superior individuals of 
society, like Bismarck, Gladstone, Greeley, Webster, etc. 
If we find in this group the physical conformity of chest 
exactly opposite to our other group, we have added to 
our knowledge of what should be avoided, a type that 
may wisely be followed. 

It is often a question how far the aesthetic sense may 
guide us in deciding as to a physical standard. The eye 
will ordinarily be pleased with the form that has scien- 
tific perfection. A well rounded and developed body is 
more pleasing than a lax, untrained one, but there may 
be sentimental and unjust standards of criticism, the 
result of faulty training in youth, that bias even our 
judgments of beauty. 

This is seen everywhere in the world of fashion. A 
head of hair that is considered beautiful and becoming 
one season must be bleached or dyed to some other color 
in order to be "perfectly lovely" the next. This 
depraved taste that approves of a pale face and crooked 
spine in a student, and a narrow waist with constricted 
chest and pelvic displacements in a woman, must be 
educated up to the scientific and artistic standard. We 
must show in the gymnasiums that increased health 
means not only increased ability, but increased beauty, 
and that health is only a correct balance of functional 
activities. It cannot exist in perfection if one part is 
under-developed or over-developed. 

This brings us to the first point in prescription. If we 
discover an abnormality of shape due to extraneous 
causes we should first prescribe the removal of these 
causes when possible. To forget this would be to give 
medicine to counteract a poison while permitting the 






Prescription of Exercise. 183 



patient to ingest more of the deadly substance. In work 
with both sexes the matter of dress should be inquired 
into where we find any suspicious abnormality of shape. 
This is especially true of constrictions of the trunk. 
Boys will often wear a belt in imitation of some noted 
*' slugger" or local "tough," or for other reasons known 
only to themselves. The injurious effects are the same 
as those seen in the case of corset-afflicted women — 
weak lumbar muscles, narrow loins, pendent abdomen, 
varicose veins, costal respiration, digestive ailments, etc. 

The muscular weakness cannot be cured while circu- 
lation is impeded by pressure on the fibres ; the narrow 
waist cannot be brought out into correct outline, to give 
room for a proper location of the digestive organs, that 
would relieve the supra pubic distention, while every 
force is crowding them down into the pelvis. 

The respiratory act should be unimpeded or imperfect 
oxidation will result and this means virtually an enforced 
vitiated atmosphere. A reduction of waist-girth by 50 
mm. is shown by Dr. Sargent to reduce the lung capacity 
twenty per cent. A number of persons with an average 
lung capacity of 2.70 litres, and waist girth of 710 mm. 
were found to have a lung capacity of only 2.15 liters 
when the waist girth was reduced to 660 mm. 

A reduction of the oxygen in the air by diluting it 
with nitrogen or carbon dioxide to the extent of 
twenty per cent would soon be disastrous to active life. 
Again, constriction of the waist calls for an entirely arti- 
ficial method of respiration, as has been conclusively 
shown by Dr. Kellogg, through whose courtesy the fol- 
lowing illustrations of normal and abnormal respiration 
are given on pages 184, 185. 

After looking at these illustrations, that explain them- 
selves, two questions might be suggested by any person 
not fully acquainted with Anatomy and Physiology: 



Plate I. 




Costal. 



Abdominal. 



I 



Fie. 1. Man. 




Costal. Abdominal. 

Fig. 2. Civilized Woman (Unmarried, age 33 years). 




Costal. 



Abdominal. 



Fig. 3. Chinese Woman. 




Costal. Abdominal. 

Fig. 4. Indian Man (Chickasaw). 




Costal. Abdominal. 

Fig. 5. Indian Woman (Chickasaw). 




Costal. Abdominal. 

Fig. 6. Chippeway Indian Woman. 



Plate II. 





Costal. Abdominal. 

14. Woman at Seventh Month of Pregnancy. 



Costal. Abdominal. 

Fig. 15. Woman, a Week Before Confinement. 




Costal. Abdominal. 

Fig. 16. Man with Enlarged Spleen. 




Ordinary. Forced, 

Fig. 1\ Respiratory Tracing (Vaginal). 



Ordinary. Forced. 

Fig. 18. Vaginal Tracing, with Corset. 




Without Corset. 

Fig. 19. 



Tightening 
Corset, 



With, Corset. 



With and Without Corset. 



1 86 Prescription of Exercise. 

First, Does not the amplification of the costal curves 
•during compression show that the respiratory act is 
fairly complete — one set of muscles acting when the 
other is impeded? This view has been presented in arti- 
cles by Dr. Mays, to which reference has already been 
made, who attempts to show that this method of breath- 
ing may tend to prevent tuberculosis by causing a bet- 
ter action of the apices of the lungs where that disease 
usually locates. The only support brought to this the- 
ory was the fact that more men than women die of pul- 
monary tuberculosis, but when we remember that this 
disease is largely due to climatic influences of which 
wide and sudden variations are the chief features, and 
that men are more exposed to these variations than 
women, the argument seems worthless. 

But even if we concede a possible safeguard against 
tuberculosis in tight lacing we must still look upon it as 
a case where the remedy is worse than the disease, or a 
disguised blessing of the kind described by "Josh Bill- 
ings," who remarked that "tight boots are a blessing, 
inasmuch as they cause a man to forget all his other 
miseries." 

Second, If costal respiration is prejudicial to health 
why do we not have a larger death-rate from acute lung 
diseases and other diseases directly traceable to inter- 
ference with respiration? 

The reply is ready that the impaired activity of one 
organ rarely gives evidence in physical signs of its abnor- 
mality. Even as sensitive an organ as the brain may 
disclose its disordered function, not by pain in the head, 
but by the abnormal secretion in some remote organ ; or 
a disease of the kidney be discovered by its causing an 
organic change in the heart. The lungs are ordinarily 
capable of enduring great hardship. Their flexibility 
•enables them to conform to any shape of the thorax or 



Prescription of Exercise. 187 

to be compressed for a long time by a pleuritic effusion, 
or other cause, without permanent injury as is frequently 
seen in cases of extreme kyphosis. According to the 
statistics of the New York Mutual Life Insurance Co. , 
consumptives average one and a half inches less in chest 
girth than non-consumptives. 

But meanwhile how fare the organs that are dependent 
■on good blood? The brain cannot act well from the 
instant unoxidized blood flows in to supply it Lowered 
vitality is the result with a yielding to acute diseases of 
every kind. Many a death is recorded as due to typhoid 
fever, peritonitis, malaria, etc., that is really due to a 
deficient respiration when the system requires the most 
active oxidation. The respiratory power is recognized 
as of the highest importance in all acute diseases. 

The same care must be exercised in judging whether 
or not a bad form is due to faulty habits of posture. If 
the respiration is checked by a position that brings a 
bend in the trunk with a depression across the upper 
part of the abdomen, as is the case when one slides for- 
ward in his seat until the - sacrum instead of the ischia 
bears the weight of the body, the same ill results will be 
found that are noticed in tight lacing. The horizontal 
•depression due to the above cause will sometimes be 
found as high as the fifth rib, causing the "creased 
chest, ' ' and we can readily understand the interference 
with circulation that must exist in such cases. In all 
there will be more or less disturbance of the hepatic 
function, impaired digestion, constipation and atrophy 
of the lumbar muscles! Correct "form" while exercis- 
ing is of special importance in these cases. 

Attention was many years ago directed to the impor- 
tance of the pelvic position, but comparatively few have 
undertaken a thorough study of what may be considered 
a normal tipping. If we take as the original position the 



i88 



Prescription of Exercise. 



horizontal, we may measure by degrees of an angle the 
departure of the pelvis from this initial position, and thus 
record what is called the obliquity of the pelvis. An 
instrument, Fig. $6, for this purpose was first devised by 
Dr. Mosher and put into practical use. * In the article 
quoted she gives the results of measuring forty-one cases, 
twenty-three of which represented 
abnormal conditions, while eighteen 
represented perfectly healthy women. 
The table here reproduced shows that 
in every abnormal case the angle of 
obliquity was as small as thirty-four 
degrees, and in only one case was 
it over thirty-one degrees; while 
among the healthy women examined 
in no case was the angle less than 
thirty-seven degrees, and in nine it 
was as large as forty degrees. The 
averages were 28. 3 and 40. i°, a sug- 
gestive variation. 

Dr. R. L. Dickinson of Brooklyn 
has studied the obliquity of the pelvis 
and his records coincide very closely 
with those taken by Dr. Mosher. Dr. 
J. H. Kellogg has also studied the 
importance of the pelvic obliquity, 
and has for many years la : d great, 
stress upon the necessitv of such pos- 
ture as shall secure a large obliquity. The outline of 
Fig. 68 is taken from a drawing made by him to illus- 
trate normal healthy poise. The author has applied the 
lines representing the angular tip of the pelvis. . 

In early life the spine is essentially straight, the verte- 
brae being so related to each other that they represent a 




* New York Journal of Gytiacology and Obstetrics, Nov., 1893. 



Prescription of Exercise. 189 

slight curve with a concavity toward the anterior of the 
body. At this time the pelvis has its brim located essen- 
tially at right angles to the line of the vertebrae, the legs 
are drawn up and a comparative shortness of the muscles 
running from the anterior trunk to the thigh results. 
When the child begins to stand erect the leg must be 
extended from the trunk, which causes a stretching of 
the anterior groups of muscles, with a consequent 
increased pull upon the other attachments. The rectus 
f emoris muscles, attached to the anterior superior spinous 
process of the ilium will tend to powerfully tilt the pelvis 
down in front, while the iliacus internus and the psoas 
magnus will act in the same manner, both running over 
the ramus of the pubic bone. While the young animal 
is creeping the weight of the abdominal organs is sup- 
ported by the mesentery and the abdominal wall. 
When it assumes the erect position the weight is no lon- 
ger largely supported by the abdominal wall, but must 
depend upon the mesentery and the floor of the abdom- 
inal cavity which will now be formed by the bony struc- 
ture forming the pubic arch. If now the normal process 
in development of tilting the pelvis downward so as to 
form this solid support for the abdominal organs is 
arrested by any process, either rachitic or postural, the 
result will be that the floor of the abdomen will be the 
soft organs contained within the true pelvis, the pubic 
arch taking a position corresponding more nearly to the 
soft abdominal wall and forming a lateral support rather 
than a foundation. The hygienic result of this abnormal 
position will be obvious, and if we bear in mind that the 
hemorrhoidal veins are not supplied with valves, we will 
understand that the position of the pelvic bones is of high 
importance in both men and women. 

The muscular condition of the loins and abdominal wall 
can tell us much about the digestion and nutritive pow- 



190 Prescription of Exercise. 

ers. If these muscles are weak we must point out the 
fact with emphasis and order such exercises as shall tend 
to give strength and activity to them. The small size of 
a man's biceps or gastrocnemius often troubles him 
when his real anxiety should be regarding his erector 
spinse or rectus abdominalis. A person's arm will 
always be large enough for the ordinary demands of life 
upon it — his heart may not be ; his leg will always be 
strong enough to fill every requirement — his stomach 
may fail utterly. A man may have life and fair health 
with complete loss of some muscles, while others act at 
the seat of life itself. 

A class of cases will come under the care of the instruc- 
tors in the gymnasiums of Schools and Colleges that will 
be rarely met by the Directors of other gymnasiums ; a 
set of boys and girls who have been overworked men- 
tally and underworked physically, until the nervous side 
of their lives is far in the ascendant. The whole idea of 
physical exercise has become repulsive to them because 
their muscular tissue is so weak that any fair activity 
begets great weariness, and sometimes even lameness. 
Brain work is easy for them because it has become the 
habit of their lives; they can generally accomplish 
great feats in the way of bearing severe strains of short, 
duration, both mental and physical. They can sit up 
all night preparing for an examination, and the next day 
are bright and ready for good work, or, at the time of 
physical examination they show a surprisingly high 
record in strength tests, but come in the next day to- 
tell of a strained back or lame shoulder as the result 
of their lifting. They make good athletes, but are con- 
tinually getting over-trained. They invariably do too 
much. 

Is gymnastic work advisable for such persons? An 
affirmative answer can only be given when there is to 



Prescription of Exercise. 19 r 

be personal supervision of the work. The boy of high 
nervous organization needs exercise quite as much as one 
who has no tendency to abnormal nerve activity, but it 
must be of a different character, for the results sought 
are dissimilar. The nervous person does not live enough 
in his muscles. His habit is to make excursions out into 
his extremities, and after stirring them up and making 
every tissue tingle he retires, to leave each muscle 
exhausted and every energy depleted. The exercise 
prescribed for these cases, and enforced by personal 
supervision, must be light and c6ntinued over a long 
period of each day. To satisfy the mental requirement 
of the case the work must be made attractive, either as 
a game or a personal contest between individuals. In a 
few cases such an interest in the physical welfare can be 
excited in the subject as to take the place of this mental 
interest that is stimulated by games, and a person will 
do routine work that is laid out simply from the enjoy- 
ment that he gets from visible improvement. 

Athletic work, on the other hand, is too stimulating to 
the nerve centers to be advisable for such cases. The 
excitement of contests will leave a person exhausted, for 
it will continually lead him to over-exertion. This objec- 
tion does not apply to those contests where skill rather 
than great strength is the source of excellence. 

Many of these persons, if uncared for in the gymna- 
sium, would shortly fall into the hands of a physician as 
typical cases of neurasthenia, and rest must often be pre- 
scribed instead of exercise. The effect of sunlight on 
these neurasthenic cases is almost always favorable, 
and consequently outdoor work should be prescribed in 
preference to indoor work. 

In marked contrast to the cases mentioned the athlete 
may be placed. Advice in regard to exercise will be 
sought, and such exercise must be prescribed as will tend 



192 Prescription of Exercise. 

to secure a development of the muscles that are least 
used in the particular form of exercise in which the ath- 
lete engages. Again, after a severe course of training 
for any athletic event, many cases will find discomfort 
from local congestions on account of an over-activity of 
the heart during the period when there is no great physi- 
ological "wear and tear" to require a very active circu- 
lation. To meet these cases a course of training must be 
laid out that shall be graduated from heavy work down 
to light, so that the person may slowly accustom him- 
self to the new conditions under which he must live. 
The heart of an athlete, who has been properly trained, 
is usually in good condition,, and a very small percentage 
develop any heart lesion during their training, but a 
large ovsr-strong heart may be an actual disadvantage to 
a man leading a sedentary life, as a puny, feeble heart 
surely is. 

The examiner will find many cases of nutritive debility 
and nervous irritability. Among men a large per cent 
of these cases will be inordinate users of tobacco. The 
very first glance will betray to the experienced eye the 
"something wrong," but we must always remember that 
some of the most persistent users of tobacco are strong 
and hearty while a few of those who do not use it are 
weak and nervous. How then shall we say to a person 
who asks our advice whether he is suffering from nico- 
tine poisoning or not? 

In the first place the heart action under continued influ- 
ence of nicotine is peculiar and attention is called to the 

s p h y gm o - 

gram, Fig. 

69, of a typ- 

Fi «- 6 9- ical pulse of 

a "tobacco heart," from the Reference Handbook of the 

Medical Sciences. It will be noticed that the first two 



Prescription of Exercise. 193 

beats are essentially normal with the tidal wave as marked 
as the dicrotic. The interval between the second and 
third waves is longer than the first which may be consid- 
ered the normal for this case. The third interval is short 
and the dicrotic notch deep while the systolic wave is 
not high. The fourth interval is normal ; the fifth longer 
and followed by a very faint impulse after which the 
heart again rallies, and so on. 

The character of this pulse as felt at the wrist is irreg- 
ular and tremulous. A beat or two of high tension fol- 
lowed by one of low, or there may be no rhythm discov- 
erable. 

These cases should be studied carefully and repeatedly 
to distinguish them from the frequent pulse o£ nervous 
excitement or the palpitation and irregularity of chronic 
indigestion. In perhaps three-fourths of the cases there 
will be some nervous excitement attendant on the new 
experiences of a thorough examination but this influence 
on the pulse may be either quickening or depressing, and 
these changes come during cycles covering many pulsa- 
tions. 

An intermittent pulse may not be an indication of seri- 
ous interference with health or longevity and may not be 
due to any appreciable cause. The omission is then 
usually found at stated intervals not very short, but from 
ten to a hundred beats apart. It is not a condition to 
safely endure the hardships of athletic training but vig- 
orous exercise may be prescribed. 

Of course the examiner's duty is clear in each discov- 
ered case of smokers' irritable heart, and it is only sug- 
gested that other narcotic stimulants, like tea and coffee, 
will produce effects that are nearly similar. In these 
cases the exercise recommended must be light, and such 
as tends to relieve the circulation. 

In studying the growth of a class in Yale it appeared 



194 Prescription of Exercise, 

that if this growth be expressed in the form of percen- 
tage the weight of the non-users increased 10.4 per cent 
more than the regular users, and 6.6 per cent more than 
the occasional users. In the growth of height, the non- 
user increased 24 per cent more than the regular user 
and 1 2 per cent more than the occasional user. In 
growth of chest girth the non-user has an advantage 
over the regular user of 26.7 per cent and over the occa- 
sional user of 22 per cent, but in capacity of lungs, the 
growth is in favor of the non-user by 77.5 per cent when 
compared. with the regular users, and 49.5 percent when 
compared with the irregular users. 

The matter of tobacco smoking as an influence upon 
the physical development of Amherst students has been 
studied in the history of the class of '91. Of this class, 
71 per cent had increased in their measurements and 
tests during their whole course, while 29 per cent had 
remained stationary or had fallen off. 

In separating the smokers from the non-smokers, it 
appears that in the item of weight the non-smokers have 
increased 24 per cent more than the smokers ; in height 
they have surpassed them 37 per cent, and in chest girth, 
42 per cent. And in lung capacity there is a difference 
of 8.36 cubic inches (this is about 75 per cent) in favor 
of the non-smokers, which is three per cent of the total 
average lung capacity of the class. 

It has long been recognized by the ablest medical 
authorities that the use of tobacco is injurious to the 
respiratory tract, but the extent of its influence in check- 
ing growth in this and in other directions, has, I believe, 
been widely underestimated. 



CHAPTER XIV. 

THE EXAMINER HIMSELF. 

And now a word in regard to the examiner himself; 
It is obvious that a medical training is of very great 
advantage to the person who is to make such physical 
diagnosis and measurement as shall be strictly scientific 
and accurate. If the examiner has not a medical education, 
let him always err on the safe side in a doubtful case and 
require a certificate from a physician before entering on a 
course of advanced exercise, or athletic work. But first let 
him study the case, using all the light that can be thrown 
on it from books and the history that can be obtained. 
The examiner must be a student, he must learn, he must 
study, examining not only the client but books, papers, 
periodicals. Anything bearing on his subject should be 
studied and questioned, but not criticised until he is sure 
of some error ; then let him correct the error by showing 
its inaccuracy of fact or logic. 

The examiner must have a thorough knowledge of 
anatomy and physiology, for in no other way can he 
become competent to advise a person regarding either 
health or exercise. To prescribe the same exercise 
for a person whose system is starved by malnutrition 
that we would for a person suffering from pleth- 
ora would obviously be productive of unsatisfactory 
results both to the pupil and to the teacher. It must be 
remembered that malnutrition may be due to any one of 
several causes, and that while some of these will be 
removed or alleviated by exercise, others might be seri- 
ously aggravated. We must know how the machine 
is constructed and under what conditions it can work 



196 The Examiner Himself. 

most favorably before we can rightly attempt to adjust 
its mechanism or interfere with its ordinary working. 

It is no longer a question of understanding Physiology 
that we may be able to care for the sick — we must know 
it, that we may understand the law of normal action for 
every organ and that harmonious inter-relation of all 
that constitutes health. Health is of more consequence 
than sickness, for it should be the constant condition of 
life varied only by the accidents to which all are subject. 

Science has taught us that in living organisms func- 
tional activity must be kept up or there will be no devel- 
opment. A group of organs unused will atrophy and 
become useless. Heredity soon stamps a deformity, that 
has been developed in two or three generations, as a type, 
and succeeding generations that do not possess that 
peculiarity are looked upon almost as new varieties. This 
is especially true of physical defects that impair the 
vitality of the parents. Notice the stress laid upon this 
law by life insurance companies where business interests 
have no bias from sentiment. The excellent health of 
the applicant is not enough if there be a record going 
back two or three generations of degenerative diseases 
that have proved fatal, or if the constitutional vigor has 
been so weak as to let the life go out at about forty-five 
or fifty years of age from any immediate cause. 

The first lesson that we must learn from this truth is, 
that health cannot exist if vital organs are seriously unde- 
veloped. 

Health is the condition of harmonious adjustment of 
all the functional activities. For instance: a normal 
pulse rate is from 72 to 76 beats per minute under ordi- 
nary conditions of rest, but a pulse-rate of 72 after a half- 
mile run might be considered abnormal and the ground 
for solicitude — for health would demand an increased 
activity of the heart muscle to supply increased blood 



The Examiner Himself. 197 

currents to the active muscles, that waste products may- 
be eliminated and restorative elements supplied. But 
further: an adjustment of the pulse rate is not all that is 
to be required in the case cited, for there must be a cor- 
responding increase of respiration for elimination and 
oxidation. And so the perfect activity of any organ — 
even the brain — may be shown to be dependent on the 
healthy activity of other organs, while the converse may 
be stated as a physiological truth, viz: that the imperfect 
action of any organ impairs the function of all others to 
some extent. A healthy muscle is, then, dependent on 
a healthy stomach, heart and brain, no less than on good 
food, air, etc., while the more refined intellectual pro- 
cesses are also based on a normal condition of the phys- 
ical organs. 

So practical a business man as the Hon. Thomas G. 
Shearman says: "I do not underrate the value of pure 
mental training, especially as that is nearly all which I 
have myself received ; but my very lack of training in 
physical labor has led me to observe the great value 
which it has not merely, with reference to bodily health 
and strength but for the very purpose of enlarging the 
mental faculties. "* 

A system of education that has in view the symmet- 
rical relations of mental and physical qualities, cannot 
ignore the necessity of beginning physical training with 
the mental. The child should come under the care of an 
experienced instructor in physical training from the day 
of entrance to regular school life. A physical examina- 
tion should be made that should determine the condition 
of heart, lungs, spine, muscles, skin, eyes and ears. 
Many a case of incipient disease that eventuates in disas- 
ter, would be discovered, and put in the care of a physi- 
cian, if necessary, or a correct regimen inaugurated with 
the aid of the parents, that would counteract the ten-- 

*Rep. of 3d annual meeting of Amer. Econ. Assoc., Phila., 1889. 



198 The Examiner Himself. 

dency to disease or deformity and save the child as a use- 
ful member of society. 

To undertake this important duty will be the function 
of the physical director and the preparation should be 
careful and constant. Let no teacher look upon his posi- 
tion as a sinecure. There is work to be done in every field. 

Do not permit the self-satisfaction of conceit to spoil 
your ability for work. 

Do not take the statement of anybody as infallible. If 
it clashes with your own idea examine it and decide who 
is wrong. 

Do not run after everything new and think that the 
new apparatus will make exercise a pleasure and relieve 
you of your work, or the new idea will save you the 
trouble of thinking. 

Do not go through your work in a perfunctory sort of 
a way, but be enthusiastic and full of interest in those 
with whom you come into the relationship of adviser and 
instructor. 

Be earnest, careful and exact, filled with the spirit of 
hard work, or move on to some less onerous occupation. 

Do not try to find some fault with each person who 
comes under your care, nor continually decry habits that 
you believe to be bad. If you believe, as I do, that the 
use of tobacco is injurious to the majority of smokers, do 
not tell every person whose breath, Ogives him away," 
that he is "killing himself" by smoking, or that he has 
the "smoker's heart" and must reform at once if he 
wishes to rob the grave of an early victim ; for in every 
such case either you will be informed that the smoker has 
no desire to go into the business of robbing graves or you 
will be set down ab a bigot whose opinion is good for 
nothing, and whose advice is worth still less. If a per- 
son asks you if you think tobacco has hurt him, and you 
find no indication of injury, be honest enough to tell him 



The Examiner Himself. 199 

so, and your candor will so establish his.confidence in you 
that the subsequently expressed opinion, that tobacco 
has done him no good, will be likely to set him to think- 
ing. At times you are expected to express yourself 
freely, as when lecturing on any subject, but do not try 
to pour a lecture into the unwilling ears of everyone who 
may chance to fall into your hands. You do no good but 
make yourself ridiculous. 

Establish a record for honesty and ability and your 
advice will be sought. Integrity is the largest factor in 
influence. 

Endeavor to find out the actual condition of each organ 
and do not be too quick to decide on the cause of any 
abnormality. If the heart action is imperfect and the per- 
son uses tobacco remember that there are occasionally 
"bad" hearts in those who have never "used the weed." 
A lateral curvature of the spine also may be due to no 
muscular inefficiency or weakness but may indicate good 
muscular action, as in case of a shorter leg on one side. 

Do not be boastful and proudly claim to have discovered 
a new "system" or a "natural" system of exercise 
because you have by a certain method of life acquired a 
large biceps or general good physique. Your size of arm 
may have as little relation to any system as your size of 
hat. Because Dr. Tanner lived forty days without food 
he did not establish a system of living without food, and 
because some "Prof." can live comfortably by breathing 
only three times a minute it does not follow that he has 
a "system" all his own; a turtle can live all winter on 
one breath. , "- ■ 

Be conservative and at the same time progressive. 
Examine all that is new, but before you adopt it test it 
by every standard that you can bring into comparison 
with it. Remember that you will probably not discover 
a great number of new truths, nor will you undermine 



200 The Examiner Himself . 

and overthrow many of the commonly accepted theories 
and doctrines that have been enunciated in the past. 

Be modest, then, and learn much from others, claim- 
ing very little as entirely new and your own. At the 
same time it is well to remember that this science and 
art of Physical Education or Training is in its infancy, in 
this country at least, and there is much work that is 
experimental and tentative. 

Perhaps in no field of scientific research bearing directly 
on practical medicine is more to be discovered and 
demonstrated than in kinetic physiology. The influence 
of exercise on muscle, bone, nerve and connective tissue 
is not fully understood — in fact we are only working at 
the alphabet of the science as it will be developed. Much 
injury to progress has been caused by superficial obser- 
vation and extravagant claims for "systems" and methods 
that had produced fair results apparently with a select 
few and were then loudly proclaimed as a complete scien- 
tific exposition of the whole subject when they barely 
rested on a single correct principle or physiological truth. 
When the enthusiasm of the originator had died out the 
illumination was found to be meteoric and a general dis- 
trust was established. 

A quack in a community injures the reputation of 
every honest practitioner in it. Be content, then, to work 
a great deal and claim very little. Have a scientific 
theory as a basis of your work but be ready to amend it 
at any time. Study your material and you will find so 
many facts to be classified and arranged that you will 
have little time to electrify the world by some universal 
specific. If you have no material and do not work you 
will have all the more time to invent some startling 
method that shall make you rich with the money of fools 
but leave science the poorer by a filching of her name 
and reputation. 



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The Growth of the U. S. Naval Cadets. Proc. of the U. S. 
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The Growth of Children. ' Science, Vols. XIX. and XX. 

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The Relation between Growth and Disease. Trans, of the 
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Bradford, E. H. The Effect of Recumbency on the Length of 
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Enebuske, Claes J. Some Measureable Results of Swedish Peda- 
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Galton, Francis. Natural Inheritance. London, 1889. 

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Physical Measurements. Wood's Reference Handbook of the 
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Gould, B. A. Investigations in the Military and Anthropological 
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Gulick, L. Manual for Physical Measurements. 1892. 

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Hall, W. S. The Changes in the Proportions of the Human Body 
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Hansen. Ueber die Individuellen Variationen der Koerporpropor- 
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Hartwell, E. M. Law of Growth and What It Teaches. Rep. Am. 
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Report of Director of Physical Training. Boston, 1894. 

Hitchcock, E. An Anthropometric Manual, 1889. 

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The Results of Anthropometry as Derived from the Measure- 
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Hitchcock, E., Jr. A Synoptic Exhibitof 15,000 Physical Examina- 
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Summary of Averages. Proc. Am. Assoc. Adv. Phys. Ed., '90. 

Physical Measurements, Fallacies and Errors. Proc. Am. 
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Hurd, Kate C. Some of Galton' s Tests Concerning the Origin of 
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Jackson, W. S. Graphic Methods in Anthropometry. Phys. Ed. 
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Bibliography. iii 

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Porter, W. T. The Physical Basis of Precocity and Dullness. 
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^Schmidt E. Anthropologische Methoden. Leipzig, 1888. 

Scripture, E. W. Reaction Time. Rep. Am. Assoc. Adv. Phys. Ed. 

Stieda. Ueber die Anwendung der Wahrscheinlichkeiterechnung in 
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■West, G. M. The Giowth of the Breadth of the Face. Science. XVIII. 
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Am. Assoc, for Adv. Phys. Ed., 1888. 

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Statistical Tables Concerning the Class of 1891 of Wellesley 
College, Numbering 104 Women. 



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